Unnatural Causes-Teachers Guide

Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot

UNNATURAL CAUSES: Is

Inequality Making Us Sick?

A YOUTH COMPANION GUIDE

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Table of contents

INTRODUCTION

Unnatural Causes: Is Inequality Making Us Sick?.................................................3

Using This Guide…………………………………………………………………...…3-5

SESSION BREAK DOWN

Session 1: Introduction to Health, Social Determinants of Health, Health

Disparities and Health Equity……………………………....................................6-13

Session 2: Racism and Health……………………………………………………14-18

Session 3: Episode One: In Sickness and In Wealth…………………………..19-26

Session 4: Episode Two: When the Bough Breaks…………………………….27-32

Session 5: Episode Three: Becoming American…………………………….…33-40

Session 6: Episode Four: Bad Sugar……………………………………………41-49

Session 7: Episode Five: Place Matters………………………………………...50-55

Session 8: Episode Six: Collateral Damage…………………………………….56-60

Session 9: Episode Seven: Not Just A Paycheck……………………...………61-65

APPENDICES

Appendix A: Suggestions and Resources for English Language Learners…67-69

Appendix B: Icebreakers/Energizers for Any Session………………………....70-73

Appendix C: Activity Ideas for Any Session……………………….…………...74-86

Appendix D: Episode Viewing Sheet…………………………………….…………87

Appendix E: Culminating Experience Project Suggestions…………..……….88-89

Appendix F: Additional Resources from the California Newsreel…….…………..90

Appendix G: Boston-based Health Equity Resources………………..………..91-92

Appendix H: Health Agencies, Federal, State and Local……………...………93-94

Appendix I: Glossary of Terms………………………………………………….95-102

Unnatural Causes Companion Guide Collaborators……………………………..103

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Unnatural Causes: Is Inequality Making Us Sick?

About the series and the Youth Companion Guide

Produced by the California Newsreel in association with Vital Pictures, the documentary film series Unnatural Causes: Is Inequality Making Us Sick? examines the root causes of inequities in health and charges us with taking action (www.unnaturalcauses.org).

This four-hour series crisscrosses the country exploring how the social conditions in which Americans are born, live and work profoundly affect health and longevity, even more than medical care, behaviors and genes. It challenges fundamental beliefs about what makes Americans healthy - or sick - and offers new remedies for an ailing society.

As a compliment to the resources developed by Californian Newsreel (see Appendix

‘E’), this Youth Companion Guide to the series provides youth development workers, educators, and peer youth group leaders (referred to as Facilitators in this Guide) with a tool that can be used to engage young people in the social, political, economic and historical factors shaping their health, including concrete ways to take action.The series can be used as a stand-alone or to complement existing youth programs, both inside and outside of the classroom, as an enhancement to existing health, science, history and civics curricula. A variety of topics, discussion questions and activities are presented for facilitators to choose from to meet the educational needs of youth from ages 12 to 20.

Using the the Guide

This guide contains questions and activities for nine 30- 120 minute sessions that are meant to be tailored for your youth population and setting. The format laid out for each session should be used as a guide, as a facilitator feel free to choose those elements that make the most sense for your participant population. The first and second sessions are an introduction to the issues discussed throughout the series and the seven additional sessions accompany each of the seven episodes.

Overall Learning Objectives

In addition to the session-specific learning objectives, by engaging in this material, participants will increase their understanding of the public health issues that exist that directly affect communities, families, and themselves by exploring:

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the health inequities that look beyond healthcare and include social justice; the role of individuals, communities and government in addressing social and economic issues that relate to health through advocacy, including policy change; the elements necessary for a healthy community; the health challenges that urban neighborhoods face, and; local resources available and best practices to address existing challenges.

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Session structure

I. Objectives - What participants are expected to learn from the session. These are designed to be Specific, Measurable, Achievable, Realistic, and Time-bound.

II. Background This gives the facilitator a brief overview of the episode and provides context for the session. It can also be used as a resource handout for participants.

III. Key ThemesKey talking points that highlight major themes from the series. These should be introduced before each session and episode viewing. This allows participants to orient themselves and begin thinking about issues that will be discussed in the viewing.

IV. Key Vocabulary - Terms particular to each session and/or episode that are important understanding key ideas and themes. For possible age-appropriate activities for participants to learn these terms, see These can be used in a variety of ways such as context comprehension and in learning games and activities (, have participants come up with their own definitions while watching episode, playing in games such as hangman or, charades where participants act out the word, have participants to create a poem, etc). A more comprehensive listing of series vocabulary can be found in this guide’s Glossary in Appendix .

V. Optional Icebreakers/Energizers These can be used at the beginning or another section of each session to get participants comfortable with each other and to get them physically energized and ready to focus on the content of each session. It is recommended to use an energizer both before and after viewing an episode. See

Appendix A for ideas.

VI. Comprehension and Discussion Questions The documentary series presents a lot of information that may be new and overwhelming to viewers. Use these questions before, after or while viewing each episode or segment to establish a focus for viewing and/or to make sure everyone understands the core program content.

These openended questions will help participants deepen their understanding of the issues, and in some cases, of the social and economic conditions that shape health in their communities. Be creative in how you use the questions. Suggested uses include giving the questions as a journal writing or research project activity that can be done during the session or at home.

VII. Suggested Activities Use these after viewing each episode to have participants delve more actively and deeply into key concepts, or before and after exercises to help them articulate current beliefs and how those are either affirmed or challenged by that episode. Suggested activities are designed in two different time lengths to give facilitators the greatest flexibility, based upon time available and to better meet the interests of their youth group. Some activities will have ideas that can be used as take home or culminating project opportunities.

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Facilitator’s Role

The role of the facilitator is to help participants actively engage with each episode’s material through a variety of critical thinking and hands-on activities that include group discussions, games, role-plays, etc.

As a facilitator it is important to become comfortable with the materials by viewing the episodes or segments you will present ahead of time and review the corresponding activities prior to facilitating the session. To effectively guide participants through the process, it is also important to use examples that are current to speak about in order to engage the participants.

Each episode of the series touches on important and powerful social issues, including racism, discrimination and classism. As a result, reactions to the film may trigger strong emotional responses, both positive and negative, based on participants’ personal experiences. Have participants also consider how their personal experiences or concerns reflect larger systems, structures and policies.

Another important aspect to note is that many of the episodes spend more time on identifying the problem rather than discussing the solution. Therefore, keeping the discussion positive, reflecting on what was seen and discussing ways to tackle health inequities is important to giving participants hope and keeping them engaged.

Culminating Projects

While the sessions in this Guide are developed to be used as a series or stand alone, facilitators and teachers using this Guide for four or more sessions are encouraged to require a larger culminating project for participants. Given the rich content explored by each episode, the culminating project allows participants to synthesize and apply their learning. See Appendix E for project ideas.

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Session 1: Introduction to Health, the Social Determinants of Health,

Health Disparities and Health Equity

I. Session Objective(s)

By the end of the session, participants will be able to:

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Identify three factors that affect health outcomes apart from health care access.

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Recognize the difference between a health disparity and a health inequity.

II.

Social Determinants of Health

While access to health care is important for our health and well-being, we also know that the conditions in which we live and work greatly affects our health. These conditions are often called the social determinants of health. The social determinants of health are the economic and social factors that influence the health of individuals and communities. These economic and social factors, such as racism, education, and housing and employment, can facilitate or impede our opportunities to be healthy.

We know that whether or not we have good health is tied to our ability to access the social determinants that promote good health: good housing, a good education, and good jobs. These determinants and our access to them are tied to how wealthy we are and the color of our skin. For example, lower income people often subject to live in poorer housing conditions than more affluent people and racial discrimination in hiring practices bar otherwise qualified people of color from employment.

Our ability to access the social determinants of health that promote good health, such as affordable and safe housing, can contribute to how much stress we experience, which in turn affects our health. For example, residents living in neighborhoods with higher rates of community violence have been found to have higher rates of cardiovascular disease. Inequities in the rest of our lives – the types of jobs we have opportunities to, the amount of wealth we have been able to accumulate or not, the neighborhoods we are able, or not able to live in – have been shaped by social and economic policy . Compared to residents in other industrialized nations, it is the profound social inequities in U.S. society that have led to its poorer health.

Health Disparities

Health disparities are the differences in health status based on one’s gender, class, race/ethnicity, age, and education , disability, geographic location, or sexual orientation .

A significant body of research, especially since 1990, clearly shows that social inequality such as socioeconomic inequality, institutional racism and sexism, poor quality of life, and low socioeconomic status are principal causes of sickness and death.

Health disparities between individuals and groups that are the result of these larger patterns of social inequality and injustice are known as health inequities . Health inequities are the systematic and unjust distribution of the social, economic, and environmental conditions mentioned above that are needed for good health. One example of health inequity is racism and the impact it has on the birth outcomes for

Black women as compared to White women. Research has shown that Black women

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot with the same level of education, health behaviors, and income have higher rates of infant mortality and pre-term birth as compared to their White counterparts. Research points to the difference in experiences of racism and discrimination for Black women compared to White women as an important factor in explaining the higher rates of infant mortality among Black women. Another example is shown through the fact that lower income and racial/ethnic minority communities are less likely to have access to grocery stores with a wide variety of fruits and vegetables. It is often these same communities where rates of chronic disease such as Type II diabetes and obesity are higher.

Health Equity

The real challenge lies not in debating whether or not health inequities exist, because the evidence is overwhelming that they do. Rather the challenge lies in developing and implementing ways to eliminate health inequities. A focus on health equity calls for addressing the social, economic or political determinants of health in addition to healthcare,that put particular social groups at a disadvantage for good health outcomes.

A first step in working to achieve health equity requires acknowledging and addressing the root causes of inequities in health. With the understanding that our health is shaped by factors outside of the hospital setting, we will need to seek solutions that support more equitable social policies, which address and make the social determinants for good health available to all people, not just a select set of people. Achieving health equity will also need to include fields and disciplines other than health, including policy, business, education, housing, transportation and development, engineering, and human rights as just a few examples.

Addressing many of the differences in health we see offers us a unique opportunity because the situations creating them are rooted in a larger history of social injustice. In the history of the U.S., we have seen important examples of work to achieve social justice through leadership, collective action, and self-determination that have led to great improvements in health. One such example is the Civil Rights movement where we saw dramatic improvements in health for Black Americans. It is with a similar momentum that we can collectively contribute to making change for health equity.

When equitable opportunity to be healthy exist for all, health equity will have been achieved.

III. Key Session Themes

" Housing, education and employment impact our health and are known as the social determinants of health.

" Health disparity is simply a difference in health. Disparities in health that are unfair and reflective of social injustice in our society are known as health inequities.

" Health equity requires acknowledging and addressing root causes of health inequities. Addressing health equity will need to include many different

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot players because our health is affected by other things other than just healthcare.

IV. Key Session Vocabulary chronic disease /health disparities/ health equity/ health inequity/ stress/stressor/ policy/ people of color/ root cause/ social determinants of health/social justice/ wealth

V. Optional: Icebreakers/Energizers (5-10 mins)

VI. Group Discussion Questions (10-20 mins)

# What does health mean to you?

# What are some of the things that affect your health? In what ways do they affect your health?

# Do we all share the same health? If not, who is sicker and who is healthier? Why do you think this is?

# Do you think your zip code can determine how healthy you will be? Why or why not?

# Are differences in health a natural thing? Why or why not?

# What is a health disparity? What are health inequities? How are they different?

VII. Suggested Activities

A. I Agree/Disagree- 10 Things to Know About Health

B. Social Determinants of Health Collage

C. Disparity or Inequity?

D.

Examining the Data

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Suggested Activities

A. I Agree/ I Disagree- 10 Things to Know About Health (20-30 minutes)

This activity encourages participants express their opinions and share their values related to various statements posed in this activity.

Materials: Ten Things to Know About Health from the California Newsreel

1. Designate two sides of the room, one area to be the “AGREE” side and other side to be the “DISAGREE” side.

2. Tell participants that you will read a series of five statements (one at a time) and participants will have to decide whether they agree or disagree with the statement and move to the corresponding side of the room. Tell participants that they will then have one minute to discuss their views as a group to come to a group consensus.

3. Facilitator will then read a statement from bolded items on fact sheet. Example: “The choices we make are shaped by the choices we have”.

4. Have each group discuss for one minute then have each group share why they are standing where they are. Each group has 30 seconds to answer. During this time members from other groups if swayed can move over to other side and will be asked to express why they decided to move. Continue until all statements have been read.

Facilitator’s Note: This can be done before viewing episode to get participants thinking about issues discussed in episode.

B. Social Determinants of Health Collage (40-50 minutes)

Participants will learn about the social determinants of health and will explore the social and economic factors that influence health.

Materials: Facilitator paper, markers, magazines, scissors, glue, additional materials to make a collage

1. With participants, brainstorm a list of all of the things that affect our health, the health of our family, and communities. Write down responses on facilitator paper.

2. Review the list and ask group what they think is meant by or how they would define the “social determinants of health”. Once discussed, share the definition from the glossary of this guide. Take a look at the list and have group identify which items on the list they think are social determinants of health and which are biological or individual health behaviors or factors (i.e. smoking, unhealthy/fast food, exercise/physical activity.)

3. Next divide in groups or as individuals and share following diagram below. Review diagram with participants and clarify any questions or terms. Have participants develop their own “Influences on Health” model by making a collage using pictures, drawings or words.

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Facilitator’s Note: There are many ways the group can make their collage. One idea is to give each small group a single layer from the model below and have them personalize and interpret it into their own experience. With this idea, once each group is done they can layer on each part of the model below, building the model as a group.

Source: Meyers, K. Issue Brief. Racial and Ethnic Health Disparities. Kaiser Permanente Institute for

Health Policy. May 2007.

C. Disparity or Inequity? (20-25 mins.)

Purpose: Participants will identify the difference between health disparity and health inequity.

Materials: Facilitator paper, Markers

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1. On two separate sheets of paper write Health Disparities on one and Health

Inequities on the other. Ask participants to define each and provide examples.

2. Provide participants with the definitions from the glossary of this Guide and ask participants if they have questions. Provide some examples if the distinction is unclear from the ones below. Remind participants that health inequities are also disparities, but not all health disparities are health inequities. Health inequities also take into account the social, economic and political factors needed for good health, not just health outcomes. Health disparities just describe a simple difference in health outcomes between groups and individuals.

Example of Health Disparities:

Average birth weight for a newborn male infant is greater than for a female infant.

The incidence of osteoporosis in elders in greater than for individuals 35 and under.

Examples of Health Inequities:

Average birth weight of a Black infant is lower than that for a White infant, no matter if the mothers share the same health behaviors, education and income level.

For individuals whose parents did not own their home when they were a child, as adults they have a greater chance of getting a cold and other illnesses.

3. Next provide participants with a sheet to work in groups or as individuals to have them decide of the examples provided below, which they think are a health disparity and which they think are both a health disparity and health inequity. Discuss as a group.

4. Write numbers of examples on the board and chart each group’s responses encouraging discussion around different ideas and differing perceptions. Once done provide participants or explain which of the examples are health inequities and health disparities and rationale.

Examples:

1.

The percentage of uninsured Hispanics (32.7%) was higher than the percentages of blacks (19.7%), Asians (16.8%), and whites (14.9%).

Inequity. Higher paying jobs tend to offer more comprehensive health benefit packages, while lower-paying jobs—jobs disproportionately occupied by

people of color—tend to offer only limited health benefits, if offered at all, that

are often accompanied by high cost-sharing arrangements with employees.

Opportunity Agenda, Unequal Health Outcomes in the U.S.

2. Of individuals who experienced a traumatic brain injury, 53% of motorcyclists said they used a helmet compared to 41% of bicyclists. (CDC, 1997; http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5204a1.htm

)

3.

A study of the availability of pain medication revealed that only one in four

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pharmacies located in predominantly non-white neighborhoods carried adequate

supplies, compared to 72% of pharmacies in predominantly white

neighborhoods.29

Inequity. The geographic mal-distribution of services exacerbates this problem. Racial and ethnic minorities are more likely to live in segregated, highpoverty communities, communities that have historically suffered from a lack of health care investment.

Opportunity Agenda, Unequal Health Outcomes in U.S.

4.

Adults in northeastern and southern States tend to be less active than adults in

North-Central and Western States.

5.

During 1988–94, 11 percent of children and adolescents aged 6 to 19 years were overweight or obese. During the same years, 23 percent of adults aged 20 years

and older were considered obese.

6.

Low-income populations, people of color, and children living in inner cities experience more emergency department visits, hospitalizations, and deaths due

to asthma than the general population. Lieu TA, Lozano P, Finkelstein JA, Chi

FW, Jensvold NG, Capra AM. Racial/Ethnic Variation in Asthma Status and

Management Practices Among Children in Managed Medicaid. Pediatrics 2002;

109:857–865

Inequity. Bus depots and idling stations disproportionately concentrated in urban low-income communities of color (cite reference). Racial disparities in housing conditions contribute to racial and ethnic health disparities in asthma.

Data from the 2005 American Housing Survey reveals disparities in housing conditions related to lead poisoning and asthma, where Black and Hispanic households had greater reported problems due to peeling paint and rats and mice. Opportunity Agenda, Unequal Outcomes in the U.S.

7.

In 2005, Peace Corps volunteers made up a lower percentage of imported malaria cases (0.8%) into the U.S. than individuals visiting family (56.1%) who made up the greatest. CDC, 2005; http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5606a2.htm

8. In 1999 the average White American could expect to live 77.8 years, the average

African American could only expect to live 73.1 years. National Center for Health

Statistics (NCHS), Health U.S., 2006, Table 27

Inequity. Factors contributing to poor health outcomes among African

Americans are the result of social injustices that include racism, discrimination,

cultural barriers, and lack of access to health care. T he Health Care Challenge:

Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality.

United States Commission on Civil Rights, Sept. 1999.

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D. Examining the Data (20 minutes)

Purpose: Participants will analyze health outcomes data between different

racial/ethnic groups and become familiar with the difference between health

outcomes and factors affecting health.

Materials : Copy of various graphs showing health outcomes (diabetes, obesity/overweight, cardiovascular disease, infant mortality) and factors affecting health by race/ethnicity (housing, access to green space, transportation poverty, income, education, employment) you may use the Mayor’s Data Report ,

URL:www.bphc.org/disparties and the Boston Indicators Project , http://www.tbf.org/indicatorsProject/ or data from your local health department, chart paper or board divided into two columns one labeled “Health Outcome” and one labeled “Factors Affecting Health”.

1. Hand out a copy of one chart or graph to each individual or group that shows either a health outcome or factor affecting health. Have participants take 5 minutes to summarize what they see in their chart or graph and write down their summary on a note card.

2. Have participants share their summary and place their summary under either the

“Health Outcome” or “Factors Affecting Health” column. Ask participants what patterns they see.

Process questions:

# What patterns do we see in the graphs under Health Outcomes and the Factors

Affecting Health?

# Are these patterns natural? Why or why not?

# Why do these patterns exist?

# What can we do to address the patterns we see?

# What resources exist to address the patterns we see?

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SESSION 2: RACISM AND HEALTH

I. Objectives

By the end of the session, participants will be able to:

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Describe how race is a societal construct.

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Name three levels of racism and provide examples.

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Describe 2-3 ways that racism and health are connected.

II. Background

The differences in health that we see between people of color compared to white people are known as racial and ethnic health disparities. Racial and ethnic disparities that exist in health result in worse outcomes among people of color and are independent of socioeconomic status, education, genetics, personal health behaviors, patient preferences and treatment refusals. For example, we know that education is an important factor for health, the more education we have the better our health will be.

Yet, shockingly research has found that babies born to Black women with a college degree are still more likely to die than babies born to White women with a high school education.

Three Levels of Racism: Internalized, Inter-Personal, and Institutional

So what is racism exactly and where does it show up in our society? Dr. Camara Phyllis

Jones , describes racism at three levels: internalized, inter-personal and institutional.

Institutional racism is fundamental to other forms and must be addressed to see real change. Institutional racism refers to the existence of systematic policies and practices within an institution that have the effect of disadvantaging certain racial or ethnic groups. One important example of this includes racial segregation that is the result of federal housing policies that have restricted home buying loans to African

Americans and other people of color. Another examples is bank lending policies that increase the cost of services to residents in communities of color. Internalized racism refers to the acceptance by member’s of oppressed races of negative messages about their intrinsic worth and abilities. Inter-personal or personally mediated racism can be considered prejudice and discrimination; prejudice being differential assumptions about motives and abilities based on some one’s skin color or race and discrimination as the action of differential treatment towards someone based on skin color or race.

Racism and Health

Race is a social construct capturing the social classification of people in a race conscious society. It is not a biological phenomenon that reflects innate differences. Yet despite the fact that the idea of race has been disproven as an objective and scientific way to differentiate people, we find that opportunity is systematically given or denied to us based on our race. In the case of health, the differences in health outcomes between

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot people of color and white people are also not biologically based. Evidence clearly shows that differences in health are not attributable to genes for poor or good health.

Rather, research has found that race associated differences in health outcomes may be due to the stress posed by racism and discrimination in our society. Racism and discrimination act as constant and unrelenting stressors in one’s life, which causes poorer health outcomes for people of color.

Increasingly, research is pointing to racism and discrimination as the root causes of racial and ethnic health disparities. Experiences of interpersonal and internalized racism can be chronically stressful and wearing on the body’s immune system. We have seen that social and economic policies that support the social determinants of good health such as sound housing, gainful employment and access to higher education have led to improvements in health. Yet, due to institutionalized racism people of color have historically and systematically barred from these and other social determinants of health which lead to good health. Racial and ethnic health disparities are considered a health equity issue because they are the result of social injustice attributed to racism and discrimination.

Addressing Racism

Changing institutionalized practices is difficult but not impossible. The first step in addressing the legacy of racism in the U.S. is recognizing and acknowledging that racism still exists within our society. Once we fully acknowledge racism as a root cause of inequity we push to change institutions and policies. Throughout history civic engagement and social movements have been important pillars to create change and challenge institutionalized discrimination. Examples of important social movements to turn the tide of racism include the Civil Rights and Black Liberation movements.

The Race Timeline developed by the California Newsreel for RACE: The Power of An

Illusion has additional information on the history of racism and important social movement in the United States.


" Race is a social construct and does not have a biological basis.

" Racism and discrimination have an impact on our health.

" Racial and ethnic health disparities are the result of racial and ethnic bias in society and are therefore unjust and preventable.

" Racism happens at different levels and has been an important part of denying access and opportunity to the social determinants for good health for all.

" Racial equity has been actively sought through social movements and civic engagement.

IV. Key Session Vocabulary

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot discrimination/ ethnicity/ internalized racism/ personally mediated racism/ race/ racial and ethnic health disparities/ institutional racism/ stressor

V. Optional Icebreakers/Energizers (5-10 mins)

VI. Discussion Questions (10-20 mins)

# How would you define race? What does it mean to you?

# How many races do you think there are? What are they? How do we decide which race someone belongs to?

# Where do our ideas about race come from? What are the sources of our information?

# How long do you think the idea of race has been around? Where do you think it come from?

# When were you first aware of people from other races?

# When were you first aware of yourself as a member of a particular racial group?

Facilitators’ Note: For more information on the history of race as an idea and social construct related answers to the questions above take a look at http://www.pbs.org/race/003_RaceTimeline/003_01-timeline.htm


The activities below have been adapted from the PBS website: RACE:The Power of An

Illusion .

A. Understanding Race

B.

Writing about Race

Additional Lesson Planning/Activity Resources

For more in depth activities and lesson plans that take an in depth look the history of race and racial discrimination in the United States go to RACE: The Power of An Illusion website at http://www.pbs.org/race/000_General/000_00-Home.htm

.

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A. Understanding Race (30-40 mins.)

Purpose: Objectives of this activity are to explore and challenge participants’ preconceptions of race and to understand race as a social construct.

Materials: Access to the internet, “10 Things to Know About Race” Handout http://www.pbs.org/race/000_About/002_01_a-godeeper.htm

1. Explain to participants that in order to learn more about health and health disparities and, in particular, racial and ethnic health disparities, that it is first important to understand what race is. Invite participants to share their own definitions of race.

Next share the following definition from the glossary of this guide: A social construct that artificially divides people into distinct groups based on characteristics such as physical appearance (particularly skin color), ancestral heritage, cultural affiliation, cultural history and the social, economic, and political needs of a society at a given period in time. Race is not a biological phenomena that reflects innate differences. Ask participants for thoughts or questions they may have about definition.

2. Next hand out copies of the “10 Things to Know About Race” and discuss as a

group. You may have participants read aloud each idea out loud or just read to

themselves.

3. Next ask participants to do the " Sorting People " activity on the Race: The

Power of An Illusion companion website. Have participants record and share

how many people they were able to correctly sort overall and across each

category.

2. Once they finish sorting, have participants go deeper into the activity to learn (a) how

the U.S. government would classify these people; (b) how each person self-

identifies; and (c) each person's ancestry.

5. Process questions:

# What did you learn from doing this activity?

#

#

Were you surprised about the activity? If so why?

Did activity challenge any assumptions you had? If so in what ways?

What does this activity tell us about race in the United States? #

Extension activities:

$

Look at the Going Deeper section of Sorting People for a summary of main points and additional activities.

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$

Look at the Race Timeline , URL: http://www.pbs.org/race/003_RaceTimeline/003_00-home.htm

Have participants answer: What is most interesting new fact to you? Is there

anything about race you know of that is missing?

B. Writing About Race (15-45 minutes)

Purpose: These writing activities below allow participants to personally reflect and critically think about the issue of race in U.S. society.

Materials: Journals

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Ask participants to write a personal essay describing the first time they were made aware of race. Was it theirs or someone else's? What were the emotional connotations?

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Have participants write an essay taking a critical look at the issue of race by analyzing some of the most popular television shows and movies. Have participants consider some of the following questions: What sort of races/ethnic groups are being represented? Examine roles that portray nonwhite characters.

Are they positive or negative? Diverse or stereotypical? Minor or lead roles?

Take a look at representation of race in newspapers and television news media.

When does race get mentioned and when doesn't it? How are various groups portrayed? Are minority viewpoints represented? Pay close attention to the language used.

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Have participants research their family history. How long has their family been in the United States? Who/when did the first members arrive? Did they face any obstacles or have any special advantages? How did race &/or ethnicity play a role?

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Session 3: Episode One: In Sickness and In Wealth (56 mins.)

Note: Given length of this episode facilitators should consider showing episode in two parts of 30 minutes each. See DVD scene guide to identify stopping point.

I. Session Objectives

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Participants will learn about and analyze the social and economic factors of poor health in the United States.

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Participants will identify the health challenges and assets in their lives and propose strategies to address their most pressing challenges.

II. Background

Compared to other industrialized nations , the U.S. has the worst health. Today, the top one percent of Americans owns more wealth than the bottom 90% combined.

Economic inequality is greater than at any time since the 1920s and the U.S. has the greatest income inequality compared to other industrialized nations. This is concerning because we know that in the United States, like other industrialized nations, there is what is called a wealth- health gradient. For each step on the economic ladder we find a corresponding step of health. In the U.S., the poorest among us and the middle class suffer from poorer health compared to the wealthiest, and the gap in illness is growing.

It is not only economics; race also matters. We see that racial inequality adds an additional negative health burden on people of color no matter their step on the healthwealth gradient. Research clearly shows that a Black person with same amount of wealth and/or income as a White person will have poorer health even though they share the same amount of wealth, power and control.

In the U.S., the poor and the middle class on average die sooner than the rich. Even more shocking is with each step on the socio-economic ladder, African Americans,

Latinos, Native Americans and Pacific Islanders often fare worse than their white counterparts of the same socio-economic status. Why is this? Those of us with more wealth are able to live in communities that have greater environmental supports for our health such as parks, numerous options for grocery stores, good housing and good education systems. Stress has been found to be an important factor affecting our health and the stress related to poor living conditions, making ends meet or living in a community with high rates of community violence are stressors that can wear on the body and negatively affect one’s health. It is no surprise then that poorer families have worse outcomes than the wealthiest.

The opening episode lays out the big picture: who gets sick and why . It explores the connection between healthy bodies, healthy bank accounts and skin color. Set in

Louisville, Kentucky, it shows how health and longevity are correlated with class status,

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot how racism imposes an additional risk burden, and how solutions lie in making equity an urgent public policy matter.

II. Key Session Themes

" Our social class affects our health. People in higher social classes live longer, healthier lives because they have more power and resources to control the decisions they make both at home and at work.

" Racism also affects our health. At every income level, even at the top, people of color often have poorer health than whites at the same level.

" Social and economic policies that distribute wealth more equally can reduce health inequities; they have in the past and they do in other countries.

IV. Key Session Vocabulary affluent/ class/ life expectancy/ public health/ racism/ wealth/wealth-health gradient

V. Optional: Icebreaker/Energizer (5-10 mins.)

VI. Comprehension Questions (10-20 mins)

# What factors, besides biological/genetic, would explain why health outcomes for twins would differ?

# If all human beings experience stress, and some would argue that stress helps to motivate us, what is the difference between the body’s normal stress response and chronic stress?

# How can social, economic, and biological factors negatively impact the health of society?

# Why do African-Americans have poorer health regardless of income?

Discussion Questions (10-20 mins)

# Does biology define and determine who you are? Is it the only thing that defines and determines us? If not what are some other things that define us?

# Do you think that ‘wealth equals health’? Why/why not?

# Do you think race equals wealth? Why/why not?

# How do the things that define you affect your health outcomes and life expectancy?

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# Should we be worried that we have a 9 th Street, like in Louisville, Kentucky?

Why?

# What policies would you propose to improve the health of others, and how could you influence these policies?

# What is social change and what are some examples happening in your community? Can this improve the health of communities? How?

# How can we eliminate/reduce the effect of stereotypes and labels on health?

# How often do you see people exercising in your neighborhood? If very often, why might that be? If not very often, why might that be?

# Are healthy food options available in your neighborhood or do you have to travel to shop for healthy food choices? What impact does this have on health?

# Can you describe what a healthy lifestyle would look like for you and what you would need for it to happen apart from your own personal health behaviors such as exercising and eating the right foods? What things would you need in order to able to exercise and eat healthy?


A.

Power reflection

B.

Ten Chairs

C.

Why So Stressed?

D. Creating a Community Health Profile


The Growth of the Suburbs and the Racial Wealth Gap from the California Newsreel

For lesson see: http://www.pbs.org/race/000_About/002_04-teachers-07.htm

United for a Fair Economy. For lesson planning resources on issues related to concentrated wealth, power, and other social justice issues see: http://www.faireconomy.org

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A. Power Reflection (25-30 mins.)

Purpose: To explore personal experiences with power and powerlessness and what

they tell us about alternative sources of power.

Materials: Print outs of political and social leaders, protesters, marginalized

groups, facilitator paper, markers

1. Ask participants to come up with a definition of power. Give each participant or group a sheet of paper and markers and have them draw a line down the middle to create two columns. Have them draw a situation where they felt powerful and one where they felt powerless.

2. Once done have each participant/group share what they drew as the facilitator jots down key words heard from experiences with power and experiences feeling powerless.

Ask participants who held power in situations where they felt powerless.

3. Review notes for each situation with each group, noting any differences in language.

Comparing the two sides ask if power is a bad thing and elicit that it is important how it used and what it is used for.

4. Next divide participants into groups and hand out one picture per group. Pictures can include a mix of the following: group of people marching or protesting, the President,

Reverend Martin Luther King, etc. Ask each group to brainstorm a list of ways the person/people or group in the picture are powerful.

5. Have each group share their picture and their brainstorm about ways in which they think people in the pictures are powerful. Ask who else can be powerful and ask in what ways? Point out that having power is important and that it matters for how and what you use it that it can have positive or negative effects on people.

6. Have participants identify five ways that they can have power as an individual and five ways to have power as a group that they wouldn’t have alone.

Extension activity:

$ Have participants research an example of the positive use of power in their community or City making a one-page case story, photo, video, or oral documentary project to share with the rest of the group. Methods for creating the case story can include but not be limited to internet searches, key informant interviews with neighborhood or City leaders, residents, and organizations.

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B. Ten Chairs (20-30 minutes), From: Teaching Economics As If People Mattered.

See www.TeachingEconomics.org

for more in depth lesson plans on wealth, class and other social issues and to download charts.

Purpose: This is a lesson plan that has participants act out the distribution of wealth in the United States. Participants will define wealth and compare wealth and income.

Materials: 10 Chairs lined up across the front of the room, one sign that says “Top

10% of Wealth,” stereo with music, chart 10b from online website www.TeachingEconomics.org

1. Ask participants what wealth is and what the difference is between wealth and income. For wealth look for answers that include money, property, natural resources, etc. Be sure to highlight that income is just money that is coming in and that even someone with a high income can have little to no wealth or could be in debt. Points to consider:

# You can have high income and no wealth I.e. someone making $100,000 a year could be spending $110,000 a year. This means they are $10K in debt.

# You can have low income and still have wealth. I.e., Someone who earns $20K a year and saves $100 a month for a year will have $1,200 assuming they have no unpaid all bills and no debt this is a bit of wealth.

# Wealth is what you own minus what you owe and is what you have in the bank and as assets.

# Eighteen percent of the population currently has no or negative assets. They owe more than they own. Some may drive fancy cars and live in big houses even though they do not own it.

2. Ask for 10 volunteers and identify one person who will be “Top 10% of Wealth”.

Have 10 participants line up behind a chair and tell group that each chair represents

10% of the wealth in the U.S. and that each person represents 10% of the U.S. population.

3. While participants are standing in a line, one behind each chair, explain that this is what wealth would look like if it were evenly distributed. One person, one chair. If wealth were evenly distributed each household would have a worth of about

$380,100.

4. Ask participants to guess how much of the total wealth they think the wealthiest 10% of the population owned in 2004. Write their guess on the board so you can refer to it later.

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5. Start the music and explain that when the music stops, it will be 2004. Instruct the student designated the “Wealthiest 10% of the Population” to lay across seven chairs; the other nine participants can squeeze into the remaining three chairs. This is a visual representation of that wealth distribution. Do not allow any participants to stand behind the chairs.

6. Encourage them to squeeze onto the chairs. Tell participants that in 2004, the top

10% of the population owned over 71% of all the private wealth and therefore this one student gets to stretch across seven chairs. Ask the participants trying to squeeze into the remaining three chairs to come up with one word or short phrase to describe how they feel about this situation.

7. Explain that even within the top 10% there is greater disparity. For example, let’s let the arm of the volunteer representing the top 10%, now represent the wealthiest 1% of the population (Wealthiest 10% participant stretches out their arm). In 2004, the share of the top 1% is 34.3% of all wealth, or equal to almost three and a half chairs.

That’s more chairs than the bottom 90% have combined. Reiterate by writing the following statement on the board: “The Wealthiest 1% own more wealth than the bottom 90% combined!” Mention that wealth is now more concentrated at the top than any time since 1929.

8. Ask the volunteers to note the circumstances they are in and their own feelings about these circumstances. Ask them the following questions:

# How are you feeling at the top?

# How about in the bottom 90%?

# How’s life at the bottom?

# Who would you push off the chairs to make room? Why?

# Look at that person at the top, how would you imagine the person at the top uses their chairs (wealth)?

# Ask the person farthest from “The Top 10%” if they can even see the person at the top.

# Are there any participants on the floor? Who do they represent? (Homeless?)

9. Ask participants, what would you say if you were told this was your own fault and

that you should have worked harder?

10. Ask participants what conclusions they draw about our current economic policy from this activity. (Is it possible that economic policy favors wealthy people and makes it easier for them to gain more wealth than the rest of us? Does it encourage the concentration of wealth?)

11. Display Chart 10b, Ownership of Household Wealth in the United States to

reinforce or summarize the 10 Chairs activity. Note that not only has there been

a significant increase in the overall private wealth owned within the U.S. (the

wealth “pie” has grown) but the amount of wealth owned by the top 1% has grown

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disproportionately. Between 2001 and 2004, the wealth of the top 1% grew 2.1%

compared to –9.2% for the bottom 20%. Note also that those on the bottom of the

economic scale have seen their net worth drop dramatically in the last few

decades, with many families in debt and owing more than they own!

C. Why So Stressed? (25-35 mins.)

Purpose: This activity has participants identify and share their perspective on the

most critical stressors affecting their health and to identify ways for action.

Materials : Chart paper, markers

1. To begin activity first make sure group understands what is meant by “stressor” and the effect stress can have on the body based on what they saw on the film. Ask each group to identify some stressors that lead to poor health. Divide participants into groups, give groups 5 minutes to list all the “stressors” they see in their lives.

2. Next give each group another five minutes and have them look at their list and pick the top three stressors that feel that have the most detrimental impact on their own health. Finally, have each group of three stressors pick what they think is the top

“stressor”. Have each group share what their top stressor is and discuss why.

3. Next have each group identify: Who or what causes the stressor, Who is affected and how (note: in some cases the who or what causing a stressor can also be affected, i.e. community violence affects both victims and perpetrators in different and similar ways), What actions can be taken at both the individual and community level to address the stressor.

4. Conclude by having each group share what they came up with.

Extension Activities:

$

If an ongoing group of youth leaders or organizers, one way to further the activity

$ can be to then select as a group one of the strategies that may be most realistic and begin to address the stressor using the strategy.

See Activity Ideas for Any Session to do a Letter Writing Campaign

D. Creating a Community Health Profile (30-multiple sessions)

Purpose: This activity can be done over several sessions. Participants will begin to

gather and organize facts/data regarding health factors. They will also be able to

think about health factors in a more synergistic manner as they share their

information.

Materials: handouts that display graphing/charting formats (i.e examples of pie charts, bar graphs, line graphs, etc.)

1. Have participants form small groups by neighborhood/community that may be local or in other parts of the country and world. You can provide them with neighborhoods

25

Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot or communities or allow them to select their own. Ask participants to recall factors affecting community health that are not related to healthcare (i.e. housing, transportation, neighborhood, food access, etc.) Tell participants they will create a community/neighborhood profile looking at both health outcomes, highlighting where there are community health concerns, as well what the social determinants of health mentioned previously look like for their neighborhood/community.

2. Have participants develop their Community Health Profile allowing them to include those things which they think are important health resources and hazards for the area they are assigned. Have participants represent the Community Health Profile using a variety of visual tools and media. Introduce participants to a variety of graphic formats, (bar graphs, line graphs, etc.) that highlight various types of health outcomes and other data related to social determinants of health such as open space, transportation, education, housing, etc.

3. Instruct participants to work together to chart various factors in a graphic/measureable format to come up with a Community Health Profile. They should work together to chart the various factors identified in a graphic/measurable format.

4. Have participants share their Community Health Profiles and have a discussion.

For Massachusetts and Boston based neighborhood health outcomes and health determinants check out following sources of information:

Diversity Data: http://diversitydata.sph.harvard.edu/

The Massachusetts Department of Public Health: http://www.mass.gov/dph/

The Boston Indicators Project: http://www.bostonindicators.org/IndicatorsProject/

The Boston Public Health Commission, Health of Boston and Disparities Project Data

Reports: www.bphc.org

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Session 4- Episode Two: When the Bough Breaks (29 mins.)


!

Participants will learn about the role of chronic stress due to racism as an

important driver of poor birth outcomes among Black/ African American

and other women of color.

!

Participants will be able to identify the three levels of racism.

II. Background

The number of infants who die before their first birthday is much higher in the U.S. than in other countries. And for African Americans the rate is nearly twice as high as for white

Americans. Even well-educated Black women have worse birth outcomes than white women who haven't finished high school. Why?

In this episode, we meet Kim Anderson, a successful Atlanta lawyer, executive and mother, who, when she became pregnant did all the right things: she ate right, exercised, abstained from alcohol and smoking and received good prenatal care . Yet, her baby was still born prematurely.

We know that in general health follows wealth: on average, the higher on the socioeconomic ladder you are, the lower your risk of cancer, heart disease, diabetes, infant death and preterm deliveries. For highly educated African American women like

Kim, the advantages of income and status do make a difference for her health, but there's still something else at play: racism.

This episode explores scientific evidence from a variety of studies that indicate that it is the cumulative impact of racism experienced over their lifetime, not innate biology, which results in such health disparities.

Note: This episode illustrates how a lifetime of exposures to racism can literally get inside the body and affect the health of our newborns. For many viewers this program can trigger strong emotions. It is essential that you allow participants the time, opportunity and space to process their reactions before proceeding with comprehension and discussion questions. Depending on the group’s size and comfort level, you may choose to do a free write, ask people to talk in small clusters, or engage the entire group in dialogue .

II. Key Themes

" There are high financial costs of prematurity on individuals and on society.

" The health of pregnant women and their babies begins long before women get pregnant. Birth outcomes are affected by the negative impact of racism over one’s lifetime, not just during pregnancy.

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" Social policies play a role in birth outcomes and health: 1960s vs. 1980s.

" Racism in America is an added source of chronic stress for people of color.

" Racial justice and civic engagement are instruments for improving health and birth outcomes.

III. Key Session Vocabulary

Life course (perspective)/ chronic stress/ infant mortality/ internalized racism/ institutionalized racism/ personally mediated racism/ prematurity/ prenatal/ preterm/ neonatologist

IV. Optional: Icebreakers/Energizers (5-10 mins.)

V. Comprehension Questions (10-20 mins.)

# Generally, people with more education and wealth are healthier than those with less education and less money. Why do you think that this is not true for most

African-Americans?

# How does stress affect pregnancy?

# How are pregnancy outcomes affected by racism and chronic stress?

# Dr. Jones says that the chronic stress of racism is like “gunning the engine of a car, never letting up.” What does she mean? How does this affect the body over time?

# Birth outcomes, like other health indicators, follow the wealth-health gradient.

Explain why wealthier and more educated mothers have better outcomes.

# According to the film, why do African American women at each income level

have worse outcomes than their white counterparts?

# Why do African American mothers – even those with college degrees –

have more low birth-weight babies than white American and African

immigrant women?


# Do you know someone who was born prematurely? How was their health as a child?

# What do you do to relieve stress? What would you like to do to relieve stress that you have not tried?

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# How can social policies affect the health of pregnant women? What policies would you want in place to help pregnant women?

# How often do you think about your race? How do you feel during those times?

# What decisions do you think youth like you make that affect their health?

# Where do you and most youth receive health care? How often to you see a doctor? Describe what receiving care is like.

# The film notes that by improving material conditions (including greater access to health care) and giving people hope for a more just and equitable future, the civil rights and anti-poverty movements of the 1960s and 1970s reduced the health gap between African Americans and whites.

• How do you think civic engagement can be good for your health?

• How can we jumpstart new initiatives that not only improve health but also

advance racial equity?

# Kim Anderson says: “People would think I’m living the American Dream: a lawyer with two cars, two and a half kids, the dog, the porch, a good husband, great family.” Kim did everything right and still her daughter was born too early. What conditions in her life might have impacted her birth outcome? What are the implications for other women of color, and what possible solutions can you suggest?

# Dr. Michael Lu asks, “What kind of nation do we want? What kind of nation do we want our children to grow up in?” How would you answer him?


A.

Fighting Stress from All Sides

B. I am What I am

C . Three levels of racism, From: California Newsreel at www.unnaturalcauses.org


For more in depth activities and lesson plans that take an in depth look the history of race and racial discrimination in the United States go to RACE: The Power of An Illusion website at http://www.pbs.org/race/000_General/000_00-Home.htm

.

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A. Fighting Stress from All Sides (20-25 minutes)

Materials: Paper, pens, flip chart

1. As a large group, come up with 3-5 examples of things in a person’s life that can lead to harmful stress (participants might list racism, poverty, joblessness) (2-3 minutes)

2. Divide into small groups with a piece of paper. For each stressor, come up with 2 ways to prevent or relieve stress. The two ways should be: What can I/a person do to relieve this stress? What can a community do to help relieve this stress? (6-8 minutes)

3. Come back together, with each group sharing their ideas to relieve stress on an individual and community-wide level. (2-4 minutes)

B. I Am What I Am- Autobiographical Reflections on our Identities (20-40 minutes),

From: Alison Zimbalist, The New York Times Learning Network

Purpose: Participants will explore the different dimensions of their own identities.

Materials: student journals, paper, pens/pencils, classroom blackboard

1. Participants respond to the following question in their journals, written on the board prior to class: How do you define "identity"? After a few minutes, ask participants to share their definitions and allow participants to freely associate words that come to mind when they see the word IDENTITY, and jot their comments on the board. Develop a class definition of "identity" (Merriam- Webster's online dictionary defines identity as "the qualities that make one person or thing different from all others"). (5 minutes)

2.Then, write the words "I am a ..." on the board, and give participants five minutes to complete the sentence with as many "identities" as they feel best represent themselves

(participants might list their race, religion, gender, family relationships, ethnic origins, socio-economic status, pastimes, etc.) Participants share their lists with the class.

Which identities were easy for participants to list, and which were more difficult? When are participants most aware of their various identities? Which identities are most important to participants at this point in their lives? (5-10 minutes)

3. Ask participants to list, create a timeline or a life map of three to five events that they feel most shaped their concept of their individual identities or made them most aware of their identities. These events can be major accomplishments or everyday occurrences, but participants should select those events that they feel were important in the realization of one or more of their identities. Ask for participants to list as many concrete

30

Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot memories (people, actions, images, and items) associated with the event, as well as abstract memories (emotions and thoughts).

4. Ask participants how their identities interact with their health by asking “How does who we are affect our health?” Remind participants that our health is connected to access to resources such as education, employment, good housing, transportation, food options where who they can may affect their access to these resources as well as in the hospital setting.

5. How can the presence of community help you or other individuals in similar situations help overcome these difficulties?

Extension Activities:

$

Invite guest speakers/orgs to share challenges, best practices and success stories

$

Discuss and introduce youth to alternative forms of relieving stress by inviting in practitioners to lead a work shop various techniques that may include Acupuncture,

Yoga, Dance, Capoeira, Guided meditation, and/or Massage

$

How do you deal with stress? Give participants an outline of the body and ask them where they feel stress and what they do to relieve it. Participants can draw, collage, write a paper, etc.

C. Understanding the Three Levels of Racism (30-40 minutes) , From: California

Newsreel at www.unnaturalcauses.org

Purpose: This activity has participants identify three levels of racism, the health

impacts of racism and to critically develop ways to combat racism.

1. To begin this activity, tell participants that you will be looking at three levels of racism:

Institutional, Personally Mediated, and Internalized. There are a few different ways to introduce the topic, some ideas follow. As a group, watch the Web video of Dr. Camara

Jones describing three types of racism (http://citymatch.org/UR_tale.php) and/or pass out Dr. Jones’ article on the same topic. Dr. Jones uses a simple gardening allegory to differentiate between structural, interpersonal and internalized racism. You can also label the levels on large sheets of facilitator paper with just the name of each level.

Provide participants or groups with the definitions from this guide and have them identify which level their definition explains.

2. Write the three racism types on the blackboard or a large piece of paper, or use the existing sheets in the room. Draw upon your own and others’ experiences coming up with a definition and several examples for each category. Try to find a wide range of examples that fit different groups or different areas of your life and society.

3. Looking over the examples, list possible health impacts and social determinants of health issues associated with each. These don’t have to be direct impacts; they can simply be related.

31



4. As a group, define what policy means. Working together or in small groups, brainstorm a few policies or actions that would help address each of these health impacts. Consider and discuss interventions at different levels (individual, community, societal) and in different arenas (public policy, private action).

5. Finally, as a group, pick one or two policies or actions that you think would make the greatest difference, then, come up with the steps that would be required to make them happen.

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Session 5: Episode 3-Becoming American (29 mins.)


!

Participants will learn about the Latino Health Paradox and how the process of becoming American erodes immigrants’ health over time.

!

Participants will explore their own and others’ identities and make connections between self determination and health.

II. Background

Recent Mexican immigrants, although poorer, tend to be healthier than the average

American. But as they are here longer, their health advantage erodes. After five years or more in the U.S., they are 1.5 times more likely to have high blood pressure – and be obese – than when they arrived. Within one generation, their health is as poor as other

Americans of similar income status.

Some researchers believe that most immigrants come to the U.S. with a health advantage, even if their native country is poor. That's because people who are able to move to another country must be in good physical and mental health to begin with.

Many researchers believe another factor is also at work. "Immigrants bring to this country aspects of culture, of tradition, of tight family social networks and community social networks that essentially form a shield around them and allow them to withstand the deleterious, negative impacts of American culture," says Alameda County (CA)

Public Health Director Tony Iton, MD.

But that shield has an expiration date. One reason is that low wages, working conditions and increased social exclusion tend to break down those protective shields.

III. Key Themes

" Recent immigrants, although poorer, tend to be healthier than the average

American. But as they are here longer, their health advantage erodes.

" Culture, tradition, tight family and community social networks shield immigrants from the negative impact of American culture, including social isolation.

" Becoming an American can have a negative impact on physical and mental health.

" Strong social networks and hopefulness may promote better health, not only in immigrant communities but for all of us.

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Latino paradox/ immigrant/ migration/ social inclusion vs. social isolation/culture/ psychiatric disorders/ acculturation

V. Optional: Icebreakers/Energizers (5-10 mins.)

VI. Comprehension Questions (10-20 mins.)

# What is the “Latino paradox?” Why are recent Latino immigrants healthier than the average American, even though they are less well off and come from poorer countries? How does this challenge the claims that immigrants are a drain on the

U.S. medical system?

# What are the causes of social isolation and exclusion in America?

# In the film, Amador Bernal says: “I water the mushrooms with a hose and watering can by myself… I earn $9.03 an hour. I work 8 hours a day, 7 days a week.” o How does economic need influence the Bernals’ ability to parent their children? o How do economic circumstances influence Bernal’s children’s ability to succeed at school?


# Do your parents work? If so, how many hours per week? Do you work? About how many hours a week? How do you think that amount of hours they/you work affects your family life?

# Define what community means to you. In what ways does your community help those who live there? How does it create challenges for those that live there?

# Describe the role that each of the following might play in eroding the family and social supports that help keep immigrants healthy:

• Poverty

• Discrimination

• Low-paying jobs

• Ineffective schools

• Substandard housing

# What aspects of your culture (as you define it) do you appreciate?

# In what ways do you think families enable young people to overcome challenges?

34


# What do you think other youth think is the “American Dream”? How accurate do you think those beliefs are?

# Do you have a Youth Center in your neighborhood? Do you use it? If not why?

What ideas to you have to make it better?

# What does a strong community network mean? What are some examples of this from your own community? How does a strong community network support social inclusion?

# What steps can a community take to increase the chances for all children to succeed in school?

VI. Suggested Activities

A.

Where Do I Belong?

B. The Immigrant Experience

C. Support Diagram Network

D. Circles of My Multicultural Self

E.

Identity Strands Forced Choice


A. Where Do I Belong? (15-20 mins.) , adapted From: The Food Project, Growing

Together by Greg Gale

Purpose: Allows participants to see and feel their own and others’ responses to the

issues of social exclusion.

Materials: Round stickers in assorted colors or small pieces of colored paper and

tape to place on back.

1. Have participants close their eyes. Put a colored dot on each person’s forehead.

Make sure that everyone has a dot that matches at least two other people’s color. The size of each color group can vary.

2. Pick two or three people, and give them a sticker that doesn’t match anyone else’s color.

3. Have participants open their eyes and, without talking, find the color group to which they belong. (Note: Be sure to phrase the instructions exactly in this way.) Tell participants that they can assist others in finding their proper group, but again they cannot talk.

4. Once everyone has found and joined a group, there will be two or three single-color people still looking for their groups. When it becomes clear to them that they do not belong to any group, have people sit down and debrief.

35



!

If you did not belong to any group, what did that feel like?

!

If you did find a group, what did that feel like?

!

Did it occur to anyone to invite the “different” ones into their groups? Why or why not?

!

Think back to the instructions you were given. Were you told not to let “singles” into your group?

!

What did it feel like to have others tell you which group you belonged in?

B. The Immigrant Experience (20-30 mins.), Adapted from the from the American

Immigration Law Foundation at http://www.drizzle.com/%7Ejyarrow/csp/csp_imgrt2.htm

Purpose: This activity introduces participants to the multiple reasons why people choose to immigrate to America and the challenges immigrants face.

Materials: paper, art supplies, magazines, interview questions, books on immigrants/film, copies of poem “Immigrants in Our Own Land” by Jimmy Santiago

Baca http://www.poetryfoundation.org/archive/print.html?id=179708

1. Ask the participants to respond to journal question: Why do some people leave their homes in other countries to come to America? Share the responses and list the reasons on chart paper or have participants read poem by Jimmy Santiago and share their thoughts.

2. Next have them define the terms immigrant and immigration . Hand out a sheet of chart paper to each individual or group. Have participants divide into two columns and label one MYTH and other REALITY. Give participants 15 minutes to write down myths and realities related to immigrants in this country. Have each individual/group present.


$

Give participants the option to write about their own immigrant experience or the experience of a family member or friend. In addition to writing about the experiences can represent those using photographs, collages, poetry. In-class participants can pair up and interview each other.

C. Support Network Diagram (30-35 mins.), From: The California Newsreel http://unnaturalcauses.org/assets/uploads/file/UC_DiscussionGuide_3.pdf

1. Social support is about having people we can turn to in a time of need and social inclusion refers to the degree and extent to which we are allowed to participate fully in society. In this activity, participants will chart who and where they might turn to for different needs.

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2. Photocopy and distribute the table below to participants. Participants can also create their own list of “Needs”. Just create a new table keeping the cells blank for participants to fill in.

Need Famil y

Friend s

Schools/

Teacher s

Employer s

Communit y or religious groups

Governmen t agencies

Financial

Medical

School/education

Fun/Entertainmen t

Food/Meals

Transportation

Family issues

3. Instruct participants that for each group under “Need” they should check the category (Family, Friends, Schools/Teachers, Employers, etc…) they rely on to fulfill those needs. Participants may mark more than one category for each “Need”.

4. Split participants into groups of 4-5 and have them share.

5. Encourage participants to define needs broadly and creatively – the idea is not to focus on emergencies but to identify different types of need and map relationships between different groups that they can trust or draw support from.

6. After about 20 minutes or when most people have finished filling out their charts, come together as a group to discuss the activity:

# What did you notice about where you might turn for different kinds of needs? Did any patterns emerge?

# Which boxes were hardest to fill? Why?

# Where is support most lacking? Are these different for everyone? If so, why?

# How does insufficient support in different areas create stress?

# How can you improve or sustain support in different areas?

# Which areas require collective action or different policies to change or improve?

# Were there certain columns or rows that have significantly have less marks?

# How can these be improved? Is the change something that must be done personally, or on a larger community or policy level?

37


# Which Columns or categories can be affected by community or policy? How can we work together to improve this?

7. At the conclusion of the activity, brainstorm some next steps to take as a group or as individuals to increase levels of support.

D. Circles of My Multicultural Self (20-30 mins.), From http://www.edchange.org/multicultural/activities/circlesofself.html

Purpose: The Circles activity engages participants in a process of identifying what they consider to be the most important dimensions of their own identity. Stereotypes are examined as participants share stories about when they were proud to be part of a particular group and when it was especially hurtful to be associated with a particular group.

Materials: Distribute copies of the Circles handout . From: http://www.edchange.org/multicultural/activities/circlesofself_handout.html

1. Ask participants to pair up with somebody they do not know very well. Invite them to introduce each other, then follow these steps:

2. Ask participants to write their names in the center circle. They should then fill in each satellite circle with a dimension of their identity they consider to be among the most important in defining themselves. Give them several examples of dimensions that might fit into the satellite circles: female, athlete, Jewish, brother, educator, Asian American, middle class, etc.

3. In their pairs, have participants share two stories with each other. First, they should share stories about when they felt especially proud to be associated with one of the identifiers they selected. Next, they should share a story about a time it was particularly painful to be associated with one of the identity dimensions they chose.

4. The third step will be for participants to share a stereotype they have heard about one dimension of their identity that fails to describe them accurately. Ask them to complete the sentence at the bottom of the handout by filling in the blanks: “I am (a/an)

____________ but I am NOT (a/an) _____________.” Provide your own example.

Instructions for steps 1, 2, and 3 should be given at once. Allow 8-10 minutes for participants to complete all three steps, but remind them with 2 minutes remaining that they must fill in the stereotype sentence.

5. Probe the group for reactions to each other’s stories. Ask whether anyone heard a story she or he would like to share with the group. (Make sure the person who originally told the story has granted permission to share it with the entire group.)

6. Advise participants that the next step will involve individuals standing up and reading their stereotype statement. You can either simply go around the room in some order or

38

Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot have people randomly stand up and read their statements. Make sure that participants are respectful and listening actively for this step, as individuals are making themselves vulnerable by participating. Start by reading your own statement. This part of the activity can be extremely powerful if you introduce it energetically. It may take a few moments to start the flow of sharing; so allow for silent moments.


# How do the dimensions of your identity that you chose as important differ from the dimensions other people use to make judgments about you?

# Did anybody hear somebody challenge a stereotype that you once bought into? If so, what?

# How did it feel to be able to stand up and challenge your stereotype?

# (There is usually some laughter when somebody shares common stereotype such as “I may be Arab, but I am not a terrorist” or “I may be a teacher, but I do have a social life.”) I heard several moments of laughter. What was that about?

# Where do stereotypes come from?

# How can we eliminate them?

Facilitators Note: The key to this activity is the process of examining one’s own identity and the stereotypes associated with that identity, then having one’s own stereotypes challenged through others’ stories and stereotype challenges. As with most activities, it can be especially effective if you participate while you facilitate. If you are willing to share your own experiences, participants are more likely to feel open to share their own.

It is crucial, especially for the final part of the activity when participants are sharing their stereotypes, to allow for silences. People will be hesitant to share initially, but once the ball starts rolling, the activity carries a lot of energy. Allow time at the end for participants to talk more about whatever stereotype they shared.

After everyone has shared their stereotype challenge, announce that anyone who would like to share another one can do so. Model by sharing another one about yourself.

E. Identity Strands Forced Choice, (20-30 minutes) , From http://www.participantsagainstsweatshops.org/blogs/northeast/?page_id=42)

Purpose: Gives participants an opportunity to explore multiple identities and how they play a role in forming identity.

Materials: 13-15 large pieces of chart paper that are labeled with the following identities: ethnicity, class, gender, race, sexual orientation/sexuality, level of education, neighborhood, spirituality/religion, body image/size, language ability, mental health/illness, ability/disability, age, family, immigrant status

1. Post the signs around the room and have the participants look at all the identities.

Have them add any that they feel are missing or not represented. Have the participants stand in the center of the room and ask them to stand under the sign that applies to them when the following statements are read.

39


2. Read the following statements and have participants stand under the sign that applies the most to them. Have a few participants share their experiences for each option, you may use a talking toy where whoever is holding the toy is allowed to talks while others listen. Debrief using process questions afterward. o People see this aspect of my identity first. o People treat me differently most often based on this aspect of my identity. o I think about this aspect of my identity the most. o I think about this aspect of my identity the least. o I know the most about this aspect of my identity. o I know the least about this aspect of my identity. o This aspect of my identity makes me the most uncomfortable. o This aspect of my identity has challenged me the most. o My parents emphasized this aspect of my identity the least. o My parents emphasized this aspect of my identity the most. o I have had the most negative experiences with this aspect of my identity. o I have had the most positive experiences with this aspect of my identity.


# How did people feel during this activity? Why?

# What do you think is the big idea from this activity?

# Did you learn to think about your identity in a different way? Did you learn something new about another person?

# Did people choose more than one identity? If so what does that mean about who we are?

40


Session 6: Episode Four- Bad Sugar (29 mins.)


!

Participants will learn about the social, economic, and political factors affecting the high rates of Type II diabetes among the Pima and Tohono O’odham native peoples.

!

Participants will explore how cultural identity and hope play and important role in health.

II. Background

The Pima and Tohono O’odham Native Americans, living on reservations in southern

Arizona have perhaps the highest rates of Type II diabetes in the world- half of all

O’odham adults have the disease. Researchers have poked and prodded the Pima

O’odham for decades in search of a biological, specifically genetic, explanation for their high rates of disease and have been hard pressed to find an answer.

A century ago, diabetes was virtually unknown here. Researchers believe that for the

O’odham and other Native Americans, the stress of living in poverty , intensified by a history of cultural, economic and physical loss, has resulted in a much larger negative impact on health. During the 20th century, the diversion of river water to upstream white settlements disrupted the Pima’s agricultural economy and way of life . Local tribes were plunged into poverty and became dependent on the U.S. government. Healthy traditional foods were replaced by foods that were high in fat, sugar and sodium.

According to Dr. Don Warne, a trained physician and traditional Lakota healer who works with the Pima, health problems like diabetes begin long before people get to the clinic or the hospital. While obesity and diet are risk factors, so is poverty. People with some of the lowest income are at least twice as likely to become diabetic as those with the highest income. This episode looks at the O’odham struggle for survival and the connection between identity, hopefulness and health. It also challenges us to think about how a new approach to regaining control over a collective future is vital to reversing the epidemic of Type II diabetes.


" Neither genetics nor the environment explain the high rate of Type II diabetes and other illnesses among Native Americans and other dispossessed peoples.

" Having a cultural identity, hopefulness and the prospect of a promising future are determinants of personal and community health.

" Community self-determination can be an important factor for health and cultural survival.

41


" In the face of adversity, marginalized and dispossessed peoples and communities have been resilient and creative in finding ways to protect their health.


Dispossessed people/ epidemic/genocide/ self-sufficiency/ Type II Diabetes / way of life

V. Optional: Icebreaker/Energizer ( 5-10 mins)


# What is an epidemic and do you think that diabetes is an epidemic for the Tohono

O’odham and Pima tribes in Arizona? Why, why not?

# How is it that the narrator in Bad Sugar, who has a college education and is and artist and photographer, still has an increased risk for having diabetes?

# What is “Bad Sugar”?

# Why do people with different histories/cultures share similar disease patterns, such as higher rates of Type II Diabetes? What similarities do you see between these peoples?

# What is the “common risk factor” for the Tohono O’odham and Pima tribes in

Arizona, which results in the highest rates of Type II Diabetes in the world?

Discussion Questions

(10-20 mins)

# What family and cultural events can you think of in which food plays a major role?

Why do you think food plays such a central role in these events?

# What needs to change in the “way of life” of the Tohono O’odham and Pima tribes in

Arizona in order for them, who live on reservations, to take back their health? Why don’t they just leave the reservations?

# What do you think is the relationship between being dependant upon government agencies and health?

# How does “hope” impact a person’s health?

# Why do the people in this film, who are living on reservations, think that diabetes is just a natural part of growing up?

# In this film, we saw that water was like “liquid gold” for the tribes. What is your communities “liquid gold”? What do you see as essential to your communities?

Consider that they could be natural resources or spiritual or cultural parts of your communities.

42


Discussion Questions, continued

# How can the Pima people enjoy a healthy and nutritious diet when they are dependent on government manufactured foods, many which are high in fat, sugar and sodium as their major food source?

# Why is access to clean water important to an individual’s health and the health of the community?

# If you have a family history of certain illnesses and disease, would you be predisposed to or more likely get those illnesses and why?


A. Good to Eat – Good For You

B. Food For Thought

C. Taking Control

D. Community Food Resource Audit

43



A. Good to Eat – Good for You (20-25 minutes)

Purpose: This activity is designed to engage participants in learning more about how diabetes, diet and culture are connected.

Materials: Access to internet to print the following: Nutrition pyramid handouts for different cultures URL: http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subje ct=256&topic_id=1348&level3_id=5732

For DASH dietary guideline information see: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/dash_brief.pdf

1. Hand out copies of the dietary and physical activity guidelines from different cultures and the DASH dietary recommendations for people with diabetes. Participants should spend time reviewing their nutrition pyramid looking at the current guidelines for daily nutrition, as well as the DASH dietary guidelines for people with Type II diabetes.

2. Each participant then plans a meal that is reflective of the food eaten by the culture/ethnicity food pyramid they have. They should then compare the meal to the appropriate guidelines and ask the group to make suggestions for healthy alternatives.

Hand out the following tips to participants to plan the meal:

#

#

#

#

#

Eat a variety of foods as recommended in the Diabetes Food Pyramid to get a balanced intake of the nutrients your body needs - carbohydrates, proteins, fats, vitamins, and minerals.

Reduce the amount of fat you eat by choosing fewer high-fat foods and cooking with less fat.

Eat more fiber by eating at least 5 servings of fruits and vegetables every day.

Eat fewer foods that are high in sugar like fruit juices, fruit-flavored drinks, sodas, and tea or coffee sweetened with sugar.

Use less salt in cooking and at the table. Eat fewer foods that are high in salt.

3. Process questions:

!

How easy or difficult was it to put together a menu?

!

How realistic is it for someone on a budget to eat the foods in your menu?

!

What else would you recommend to someone who has Type II diabetes to do besides just watch what they eat?

44


B. Food For Thought (20-30 minutes)

Purpose: The purpose of this activity is to demonstrate to what extent foods and dishes that originated in other countries have changed in the United States. Many cultures from other countries have created new diets when they live in America that has been detrimental to their health over time.

Materials: Access to the Internet

1. Ask participants to think of specific dishes or recipes that they identify as being a part of their culture or heritage and they that they eat during special occasions versus those they eat everyday. Have participants then go online and look up to see if the dishes or ingredients they listed have always been a staple of their culture or have they changed.

2. Then ask why they think those changes happened (e.g., because of necessity, government control, etc.) and how those changes affected their diet and health.

3. Have participants then share their foods/dishes with the group and discuss how and when they are typically eaten and share the history of each food/dish.

Extension activities:

$

$

Create a group cookbook with family recipes shared by participants.

Have a potluck where participants prepare and bring in family recipes to share.

C. Taking Control (20-30 minutes)

Materials: Photocopy matrix below or draw on board

Dr. Warne says that control over your life “has an impact on self-identity and one’s sense of hope for the future.” What do we need in order to feel hopeful about our futures?

1. As individuals or in small groups, have participants make a list of things that

cause worry, concern and anxiety about their future. Encourage them to think

of examples that are both personal/immediate and that reflect their broader

economic, social and physical environments.

2. Have them cluster worry items into themes or areas, i.e. education,

work/ employment, health, etc. then select 3-5 themes to work with.

3. Photocopy and distribute the chart below. (We recommend creating your own

document using the categories below or your own.)

45


Themes (list below)

Individual Community Society

4. Have participants list their selected themes in the left column, then ask them

to consider what changes on the individual, community, state and federal level

might make a positive difference for each theme/area of concern and write

their answer(s) in the box that corresponds to the category and level.

5. At the end of the activity, have each group present its work and talk about how

the activity made them feel (more or less hopeful). As a large group, discuss

the ideas that made people feel most hopeful or that might give people the

most control over their lives. Brainstorm suggestions for next steps.

46


D. Community Food Audit , Adapted from GRUB

Purpose: Participants will be able to research and identify local food resources within their own communities and share knowledge with others. Have participants to post at home, school, or hand out at church. Share the knowledge!

Materials: Double Sided print out of sheet on following page

City/Neighborhood

_________________________________________________________________

Farmers’ market [Massachusetts Federation of Farmer’s Markets, locals]

Location

______________________________________________________________________

Day(s) /Times

______________________________________________________________________

Nearby Community Supported Agriculture (CSA) Farm [localharvest.org & csacenter.org]

Name of Farm

____________________________________________________________________

Name of Farmer(s)

_________________________________________________________________

______________________________________________________________________

Phone Number

____________________________________________________________________

Member Share ($) and Due Date

_____________________________________________________

Nearby Food Coops/natural food stores [cooperativegrocer.org]

Location

______________________________________________________________________

Days

______________________________________________________________________

Hours of Operation

________________________________________________________________

Grocery Stores with Local Foods and Fresh Produce

Name

____________________________________________________________________

Name of Store Manager or Food Buyer

________________________________________________

Phone Number

____________________________________________________________________

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Your Local Organic Meat and Dairy/Egg Provider

(if you eat meat, and if your CSA doesn’t offer meat or dairy)

Name of Farm

____________________________________________________________________

Name of Farmer(s)

_________________________________________________________________

Phone Number

____________________________________________________________________

Community Gardens

Location

______________________________________________________________________

Day(s)

______________________________________________________________________

Hours

______________________________________________________________________

Congressional Representative [house.gov/writerep/]

Name of Representative

____________________________________________________________

Name of Constituent Liaison

________________________________________________________

Phone Number

____________________________________________________________________

School Food Resources [farmtoschool.org & farmtocollege.org]

(e.g. farm-to-school and farm-to-college efforts, school board members, healthy food in schools initiatives)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Other Community Food Resources [foodsecurity.org]

(e.g. local food and agriculture groups, local healthy restaurants, community garden associations, food policy councils, city council members, food banks)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

48


Extension Activity:

1. Divide participants into groups by the neighborhood or community where they live

or choose the school’s location for everyone to focus on.

2. Distribute chart paper and colored markers to each group.

3. Ask the group(s) to draw their neighborhoods/communities (or the community

around the school), labeling where each of the above resources and food sources is

located.

4. Ask a spokesperson from each group to describe their maps to all participants.

5. After each group has reported, ask questions about similarities and differences between the neighborhoods (or skip to #6 if the entire group focused on the school’s/organization’s neighborhood).

6. Ask what they see is missing or think should be changed about their neighborhood(s) to improve the quality and availability of food.

7. Ask how they could organize and work to create those improvements (lobbying legislators, etc.).

49


Session 7: Episode Five- Place Matters (28 mins.)


$

By the end of this session, participants will be able to describe the elements necessary for a healthy community, challenges that urban neighborhoods face, and describe at least one support agency and strategy to address these challenges

II. Background

Between 1934 and 1962, less than 2% of $120 billion in government-backed home loans for families to move into newly created suburb areas went to non-white households. This and other social policies have led to residential segregation and the disparate lack of investment in urban communities of color that we see today.

Segregation and lack of access to jobs, nutritious foods, and safe, affordable housing have a harmful impact to the health of residents living in urban neighborhoods where businesses and government agencies have reduced their investment in them. Studies have shown, for example, that living in such a neighborhood leads to a 50-80% increase in risk for heart disease – the number one killer in America. One reason for this relationship is said to be due to the chronic stress of worrying about violence, poor schools, and unpaid bills; living in substandard housing or a polluted environment; not having good access to fresh food, reliable transportation, or safe public spaces. Each of these concerns can have a negative, even toxic effect on health.

This episode looks at how built space and the social environment affect our health; that where we live is a good predictor of our health. Set in Richmond, California and West

Seattle, Washington this episode explores the policy and investment decisions that create unhealthy and healthy neighborhood environments and explores what actions can make a difference.

III. Key Themes

" Where you live strongly determines your health.

" Trauma and stress have a powerful impact of overall health.

" Social connectedness is important for health.

" Change needs to come from all levels and requires both community organizing and policy change in many arenas such as education and housing.


Community empowerment/ environmental support/ mixed income community/ poverty tax/ invest

V. Optional: Icebreakers/Energizers (5-10 mins.)

50


VI. Comprehension Questions (10-20 mins.)

# What factors in communities/neighborhoods affect health? How can these factors impact health in a positive and/or a negative way?

# What effect does losing jobs in low-income areas have on communities?

# What is a “poverty tax”?

# What are the key elements that need to come together to make a community?

And, if each neighborhood is composed of these elements, why are some neighborhoods different?

Discussion Questions (10-20 mins.)

# What do you think would be the long-range effects on your health, if you ate a nutritionally recommended diet, as opposed to a fast food diet?

# Can you explain why there is a 50-80% rate of heart disease in low-income neighborhoods?

# There is some debate as to whether violence is a Public Health issue. Do you think so? Why or why not?

# What are some things that a person can do, no matter what community they live in, which can improve their health?

# How can you make an unhealthy neighborhood/community healthy? If so, what areas would you focus on which would promote healthy living?

# What is one thing that you, as a young person, could do to improve the health of your community? Explain.


A . I Agree/Disagree

B.

Neighborhood Map

C.

Convince the Housing Board

D.

Public Health Investigators

51



A. I Agree, I Disagree (15-20 mins.)

Purpose: This activity encourages participants to express their opinions and share their values related to various statements posed.

1. Designate two sides of the room, one area as the “AGREE” side and other as the

“DISAGREE” side.

2. Tell participants that you will read a series of five statements (one at a time) and they will have to decide whether they agree or disagree with the statement and move to the corresponding side of the room.

3. Tell participants that each group will have two minutes to discuss their views as a group to come to a group consensus.

4. Facilitator will then read each statement aloud.

5. Next, after each group discusses their views for the two minutes, ask each group to share why they are standing where they are with the entire group. After each explanation, participants may move over to other side, if they are swayed by the other group. Ask some participants why they decided to change sides.

6. Continue until all statements have been read.

Statements

1. Wealth equals health.

2. What you eat and how much you exercise are the most important things that matter to a person’s health.

3. Our zip code determines how healthy we will be.

4. Housing is a public health issue.

5. An “unhealthy” neighborhood is the fault of people who live there.

6. Violence is a public health issue.

7. Individuals determine their own fate.

8. Communities can make a difference in the health of individuals.

9. We live in an individualistic society.

Debrief: Ask participants how many changed their views on a statement, even just a bit. Ask why they think this happened. Focus conversation on the power of communication and persuasive language. Ask how this powerful strategy could be used in community activism.

Facilitator Note : This can be done before viewing the episode to get participants thinking about issues explored in the episode.

52


B. Neighborhood Map (20-30 mins.), Adapted from: The California Newsreel at www.unntauralcauses.org

1. Divide participants into groups by neighborhood or assign to different neighborhoods.

Have participants draw out individually or in groups their answers to the following items below: Have participants list on chart paper around the room o The things your neighborhood is most proud of and least proud of o The health resources and health challenges your neighborhood faces o The health resources and health threats.

2. Next have each group share what they came up with.

3. As a large group or as individuals or smaller groups have participants answer the following questions: o What are the overall strengths of this neighborhood? o What actions could be taken to sustain those strengths? o Who can help us take those actions? o What things in this neighborhood need to be improved? Be as specific as possible. o What actions could be taken to make those improvements? o Who can help us take those actions and what we need to make the

change?

4. Pick at least one item from the list and have participants work in small groups defined as “city councilors” and identify a few concrete action steps toward change.

Report back to whole group.

Debrief: Ask participants to reflect on how it felt to work as a team; and do they think they would have been able to accomplish as much, if they were working independently?

What strengths does this time of work illicit?


5. Next have participants redraw their picture together or in groups of what they would like their street or block to look like in ten years. Ask them to consider what they would keep from their existing map and what would they added. Look for similarities and differences across the drawings. Ask participants what they think it will take for that vision to be realized.

C. Convince the Housing Board

Purpose: This activity is for participants to utilize their critical thinking,

organizational, and public speaking skills.

Materials: Rubric/checklist for criteria, and access to technology for Power

Point presentation format and LCD ( both are optional)

1. Give participants the following scenarios (or develop your own):

53

Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot a. You are the asthma health educator at the Boston Public Health Commission.

You work with families living in Boston Public Housing and you notice that in most houses where there are children under the age of 5, many of those children suffer from asthma. Pests (insects and rodents) and mildew are big problems in the houses you visit, even though you work with families who keep their houses clean. b. You are the parent of a 4- year old child. You and your child live in Boston

Public Housing and your child has asthma. Lately, your child has been having asthma attacks at night and you have to stay up and take her to the hospital. You have missed 3 days of work and your child has missed a week of school. c. You are the Chief Executive Officer CEO of a hospital in Boston. Last year, there were over 1,000 pediatric emergency room (ER) visits from children under the age of 5 with asthma. Each pediatric ER visit to treat a problem related to asthma costs your hospital $6,000.

2. As individual or in groups, participants are asked to develop a presentation based on their scenario for the local housing board. They need to convince the board that there is a need for an affordable, healthy housing development similar to High Point in Place Matters. Facilitator should provide an outline format and required elements for the presentations, which could include an outline, charts, diagrams, maps, etc.

(should be both visual and written), and review this outline with the group.

Key questions for participants to answer include: a. What is the problem or issue? b. Who is affected and how? c. How can this problem or issue be solved? d. Who needs to be a part of the solution and why?

3. Participants can use the rest of the activity time to prepare their presentations, researching and discussing additional information found on the Internet or using other sources. The facilitator circulates among the groups, providing research support and guiding brainstorming.

4. Participants should then present their arguments.

Debrief: Ask participants to reflect on how it felt to work as a team; and do they think they would have been able to accomplish as much, if they were working independently?

What strengths does this type of work illicit?

Extension Activity:

Have participants prepare oral/visual presentation for the following day or days.

Participants could also develop Power Point presentations to support their oral presentations. On the presentation day, those participants not presenting can act as

54

Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot the Housing Board, provide feedback to each group’s presentation. This activity could also build to a Capstone project.

Facilitators’ Note: This activity can be done in one session or over several depending on how much time the facilitator would like to give participants to prepare their statements.

D. Public Health Investigators, Part 1 (30 – 35 minutes)

Purpose: To have participants work in teams to research, discuss and offer solutions to various health issues in different communities in Massachusetts. During this exercise, participants will learn the importance of community empowerment and how public policies and racial and ethnic health disparities affect certain populations, as well as what action steps they can take to address these issues in their communities.

Materials: Markers, facilitator paper, print outs of health data

1. The facilitator informs the participants that they will be working in small groups to research and offer recommendations on some of society's most common health problems.

2. Organize the participants into four groups.

3. Two groups will the work on one health topic (e.g. obesity) (Team A) and the other two groups will work on another topic (e.g. breast cancer) (Team B).

4. Team A (consisting of two groups) will be given data sets and/or look on the internet for information pertaining to their particular health topic. Team B will do something similar, but specific to their health topic.

5. Team A, while still in their two small groups, will discuss the data and its significance.

In a few minutes, both groups in Team A will get together to discuss the data and what disparities they found in their data sets. They should be encouraged to write down reasons or causes for the disparities, what can be done to address those disparities and what advice they would offer the community. Team B will do the same.

6.

Teams will have about 5 minutes to recap what they discussed in their small groups.

Team A will identify two people to present their findings and the results of their discussion to their larger group (both groups in Team A), with the facilitator guiding the discussion). Team B will also present to their groups. Presentations should be about 10 minutes for each team.

Facilitator’s Note: If short on time, provide data sets and information from Internet sites to decrease the amount of time researching information.

Boston Public Health Commission Data Reports, http://www.bphc.org

Massachusetts Department of Public Health, http://www.mass.gov/dph/

55


Session 8: Episode Six-Collateral Damage (29 mins.)


!

Participants will explore the health effects of U.S. militarization and occupation in the Marshall Islands on the Marshallese.

!

Participants will consider the impact of globalization and its winners and losers.

II. Background

Two billion people worldwide are infected with tuberculosis (TB), but only 9 million people a year actually get the disease. The story of the Marshall Islands can help us understand why.

The lives and health of Marshall Islanders in the Pacific were disrupted when the United

States occupied their nation and used their outer islands for extensive nuclear testing after World War II.

After miscalculations on one of the largest explosions caused nuclear fallout to land on three inhabited islands, residents were treated, relocated, and tracked to study the effects of radiation exposure on humans.

With their lands, culture, and traditional way of life destroyed, many Marshallese now crowd the island of Ebeye hoping to get a job at the U.S. base on nearby Kwajalein.

Here, they face the worst of both the “developing” and industrialized worlds.

Tuberculosis and other infectious diseases are fed by poverty and squalid conditions.

Lack of economic opportunities and healthy food options, combined with the stress of forced relocation and cultural loss, have also led to high rates of chronic illnesses like diabetes, heart disease, hypertension, obesity and cancer.

Life on Ebeye is contrasted with Kwajalein, where American contractors and their families enjoy a pleasant suburban environment, and where health outcomes here are comparable to the U.S.

Today, around 10,000 Marshall Islanders, seeking a better future, have ended up in the unlikely place of Springdale, Arkansas. Drawn by plentiful jobs in the food processing industry and a low cost of living, most are happy to have better educational opportunities and healthier options.

But even though the Marshallese can leave the impoverished conditions of their homeland behind, they can’t escape the effects of having lived in poverty.

The health problems that Marshallese people experience today are the price they’ve paid to help the U.S. maintain a strategic military presence in the Pacific. Our relationship with the Marshall Islands has shaped much of its fate over the past 60 years; it can also help improve their prospects for life and better health in the future.

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" Globalization, uneven development, and military policies have an impact on poverty, hope, and health.

" Globalization can have both positive and negative consequences on individual and community health.

" U.S. policy in the Pacific has affected the health of Marshall Islanders directly and indirectly.

" Social changes that improve living standards can strengthen immune systems and increase resilience against disease.


Globalization/ living standards/ resilience/ tuberculosis (TB)/ displacement



# In the early part of the 20th century, tuberculosis was a leading killer in American cities. What caused the TB rate to drop 76% between 1900-1940, even before drugs to combat the disease had been invented? What factors contribute to outbreaks in poor communities?

# Dr. Neal Palafox says that for Marshall Islanders, displacement and cultural loss have been more damaging to health than the actual effects of nuclear testing.

What does he mean? How does being relocated 50 years ago affect livelihood, living conditions, diet and people’s sense of hope and opportunity, even today?

# How has the presence of the U.S. Ronald Reagan Ballistic Missile Base on

Kwajalein affected the health of Marshall Islanders on the neighboring island of

Ebeye? Why is it so crowded?

# Contrast living conditions on Kwajalein and Ebeye. What kinds of daily stressors do poor Marshallese on Ebeye encounter that American residents of the U.S. military base on the Marshall Islands do not?

# Why are conditions so different? Who has the power to make changes?


# What responsibility do you think the U.S. has to improve living conditions on

Ebeye? What do you think should be done?

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# More than 1,100 Marshallese work on Kwajalein but they are not allowed to live there and must commute by ferry to the neighboring island of Ebeye. How would you feel if a foreign power, say, France or China, occupied a slice of land in the

United States and employed Americans but didn’t allow Americans to live there?

# Dr. Jim Yong Kim says, “We have more than enough resources to provide treatment, prevention, and to transform the economic and social conditions that give rise to the diseases of poverty like tuberculosis that are so prevalent today.”

Why haven’t we done so? What factors make it difficult for the Marshallese government to make changes on its own?


A. Logo Game

B.Logo Game (Long Version)

C.Globalization: Follow that Product (requires more than 1 session)




A. Logo Game, (15-20 minutes) Based upon Globalization Lessons Plans: http://www.geographypages.co.uk/globless.htm

Purpose: The purpose of this activity is to encourage participants to consider the scope and effects of Globalization with their knowledge of geography.

Materials: large map, product logos, and pictures of those logos in different settings

(optional).

1. Show participants a variety of global product brands (e.g., Coca Cola) and ask them to identify what the product is, where it comes from, and where you can find it (what countries and/or regions).

2. Discuss that there are some logos that would be understood in Cameroon, in West

Central Africa, just as much as in the USA. What do you think the effect is of exporting/sharing products like these throughout the world? What impact does this have on local cultures?

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B. Logo Game (Longer Version)

Same as the Logo Game above, but with the additional questions posed: [Taken from: Project on Globalization, Rusty Sandefur, Cypress Woods High School, http://www.wachouston.org/0/3982/0/1175D4792/ ]

1. What are the common features of these products?

2. Which of these products are commonly available in other countries (think about the type of product and not the brand name)?

3. Which products are uncommon in other countries and why do you think so?

4. Are any of these products necessities?

5. What might a citizen of France use instead of these products?

A villager in India?

A resident of Saudi Arabia?

6. What factors might affect how these individuals view these products?

How does this compare with your view of these products?

If you think the views are similar, why might this be so? If not, why not?

Extension activity:

7. Have participants research the impact of the brands on local economies and culture.

For example, have participants look up the connection between Coca-Cola and small farmers in rural India. Have participants consider the benefits and draw backs of a global economy in their research . Have participants identify the “winners” and

“losers” of globalization.

C. Follow That Product (Two or three 30 minute sessions or 1.5 hours), From:

Project on Globalization, Rusty Sandefur, Cypress Woods High School, http://www.wachouston.org/0/3982/0/1175D4792/ ]

Purpose: The purpose of this activity is to demonstrate the width of globalization in everyday products in our daily lives. This will include picking a product of interest and tracking the history of the company, manufacturing locations in the past and now and the markets for the product. Use a product that started in the USA.

Materials: world map, poster board, markers, internet access, printer, scratch paper and pens (for research notes).

1. The Poster: Write in bold letters “The Globalization of (you product or company name).”

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2. You will pick a company and follow the path of diffusion of the manufacturing and sales of one of its products. Make certain you use a major product that began in the

USA with international breadth.

3. Use a larger picture of the product you are researching with its name and parent company.

4. After you pick a product create a history and geography timeline of 10 significant events in the growth of the “globalization” process of the product. Important dates would be the start of the company, when products were first sold overseas etc… Include company mergers along the way, (ex: Lays Potato Chips, merged with Fritos, became

Frito Lay, bought by Pepsico, which is now the parent company. You would research the product Lays Potato Chips but may have to follow the Frito-Lay or Pepsico path to find information.) The time ends with a somewhat current date. Use a line, not bullets.

Answer these questions:

# Where was the original company headquarters and manufacturing, did it move from its home country and why? Where does the manufacturing of the product occur?

# Where are their largest markets today? Which markets are growing the fastest? Is the company today dependent on foreign manufacturing and/or markets.

5. THINK! Why might there be a difference in where a food product (potato chips) is manufactured as opposed to where a consumer item (television, clothing, etc…) is manufactured.

6. Create a current demographic chart of the country of origin. Include life expectancy, literacy rate, type of economic system and government type of the country headquarters and the same information on a country where the product is manufactured.

7. Draw and color a world distribution map of manufacturing locations, company headquarters, and market area. Go to the company website for information. This may require a little investigating.

8. Create a collage of the product’s packaging and name in several of the countries the product is sold in. For instance, Lay’s Potato Chips are manufactured and sold in countries all over the world with different names and flavors. There are examples of many of the worldwide products on the Internet (Google Images is a source.)

9. Create a second collage of other products involved in globalization. You may use products from other projects in the class. Try to find foreign labels to well known products when possible. Add the country name to the product.

10. Write in bold letters (visuals are also good) 20 ways that globalization has affected you personally in a positive or negative ways.

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Session 9: Episode Seven-Not Just A Paycheck (30 mins.)


!

Participants will learn about the impacts of job security on health.

!

Participants will explore the impacts of social policies on health.

II. Background

In the winter of 2006, the Electrolux Corporation closed the largest refrigerator factory in the U.S. and moved it to Juarez, Mexico, for cheaper labor. The move turned the lives of nearly 3,000 workers in Greenville, Michigan, upside down.

Before the plant closed, Electrolux workers led a middle class life—owning homes, buying new cars and taking vacations. Now most are scraping by on severance pay, unemployment benefits and a health plan that will end in a year. As personal finances spiral downward, health follows.

In the year after the plant closure, the stresses of these layoffs have resulted in a tripling of the local hospital’s caseload because of depression, alcoholism and domestic abuse.

Experts say that heart disease and mortality are also predicted to rise – totaling 134

“excess” deaths in this area alone over the next 10 years. And the lay-offs not only affect workers but their families and the entire community as well.

As middle-class Americans find their health and way of life increasingly threatened by globalization and corporate profit-seeking, those in the top income brackets are reaping the spoils of our winner-take-all society.

In other countries, such as Sweden, the situation is vastly different, where social policies are based upon the value of shared responsibility and provide a safety net for citizens. In America, at least for the time being, workers are left to fend for themselves, and we all pay the price in both health and wealth.


" Layoffs, unemployment, and job insecurity have a negative effect on health.

" There is a widening gap between the “have’s” and “have not’s” these economic disparities impact health disparities.

" Public policies that provide a social safety net can support unemployed workers and their families during hard, economic times that affect health.

IV. Key Session Vocabulary pension/ globalization/ corporation/ capital/ outsourcing/ fair trade/ free trade


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# Why did Electrolux close its Greenville, Michigan, and Vastervik, Sweden, plants?

# What was the impact on workers in each community?

# How did the workers in these communities cope?

Discussion Questions (10-20 mins.)

# What responsibility do we have to help people who have suffered a job loss?

What policies might prevent health from getting worse in these situations?

# What is Globalization? What are the benefits and challenges due to

Globalization? How do you think Globalization affects the health of communities and individuals?

# Would you be willing to pay more, like the Swedes do, to have such guaranteed benefits as universal health care, secure pensions, job training and placement assistance, 80% unemployment pay, income supports for families, paid parental leave, and universal childcare? If not, why not? If yes, how much would you be willing to pay?

# Researcher Richard Price says, “We live in an individualistic society. And we believe that people are individually and personally responsible for their own fate.

We enact our laws that way. We create our social policy that way.” o Do individuals determine their own fate? Should they? Why? o How do beliefs in individualism and “self-made person” shape the way we view the roles of government or corporations? o How does it impact our ability to work collectively to improve conditions for health? o What other core American values might we draw upon to push for different policies?


A.

What’s My Job?

B. Basic Needs and Wants

C. Wants vs. Needs

D.

Wealth Matters



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A. What’s My Job? (15-20 minutes)

Show participants pictures of a broad range of people, differing in age, dress, gender, setting, race and ethnicity and ask participants to make speculate about what type of job the person does, salary, quality of life, etc. (can work in groups).

Ask participants to identify the assumptions they are using to increase awareness about beliefs and stereotypes about others, including about their occupations.

B.

Basic Needs and Wants (30-60 mins.), From Human Rights Here and Now, http://www1.umn.edu/humanrts/edumat/hreduseries/hereandnow/Part-3/Activity3.htm

Purpose: Participants discuss what it means when people’s basic needs are not met and the relation of basic human needs to human rights.

Materials: 3"x5" cards, old magazines, glue, scissors, art supplies

1. Ask participants, working in pairs or small groups, to create 10-20 cards that illustrate the things they need and want to be healthy and happy (distinguish needs as those things that are essential for survival--such as food, health care, shelter—from wants as those things that are desirable but not necessary for survival, such as iPods, jewelry, fashionable clothes, etc.). They may draw these things on the cards or cut out and paste images from magazines.

2. Each pair or group exchanges cards with another. The group then sorts out the new cards into either “needs” or “wants”; put into another column those that are neither needs nor wants.

3. The groups who exchanged cards join together and compare their cards. They then try to reach agreement on categories for all the cards. When they have done so, discuss:

# Which pile of cards is bigger? Why?

# If you had to move two cards from the NEEDS pile to the WANTS pile, which two would you choose? How would your life be affected by this change (e.g., if something you feel you really need were no longer available to you?)

4. Ask all of the participants/groups to combine their cards by category. Attach them to the wall or blackboard to complete a class list. Discuss:

# Are all human needs included in the NEEDS list? Are there other needs that should be added to the list?

# Are all the wants included? Can the class think of others?

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5. Process Questions:

# Is it easy to differentiate between wants and needs?

# What happens to someone when his or her wants are not fulfilled?

# What happens to someone when his or her basic needs are not met?

# What happens to a community when many people’s basic needs are not met?

# Are there people who don’t have their basic needs met in the world? In the USA?

In your community? In your school?

# Are there some kinds of people who often don’t get their basic needs met?

# Who are they and should their needs be met? Why?

# Should some people have their wants satisfied when others don’t have their needs met?

# What can be done to meet people’s basic needs?

# Whose responsibility is it to meet people’s basic needs?

# What actions can you take to help meet the basic needs of others in your community?

C. Needs vs. Wants

Purpose: This activity has participants take a critical look at their personal choices

and think about them within the larger context between needs and wants.

Materials: facilitator paper, markers

1. Explain what NEEDS are and what WANTS are as it relates to money

management/budgeting.

2. Break class into 2 large groups.

3. Give each group a paper and tell them to draw a line down the middle of the paper

and then write NEEDS on the left side-top, and WANTS on the right-side top of the

paper.

4. Ask them list everything that they purchased over the past 2 weeks in either the

need or want columns along with how much they had spent for each item. e) Have

them total each column at the bottom of the sheet.

5. Ask each group to add each member’s totals (i.e., collective grand total for NEEDS

and another for WANTS).

6. Process questions:

How did you decide what was a NEED vs. a WANT?

Ask a few participants to describe some of their NEEDS and WANTS, why they were chosen and if anyone else sees any item mentioned differently and why.

Ask how they could have spent their money differently and why.

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D. Wealth Matters, (90-120 minutes) From: A Lesson on Work, Class and Access ,

Samantha Elliott Briggs and Jennifer Holladay adapted this lesson for Teaching

Tolerance from Life Happens , a game created by Tracy Ore, Assistant Professor at

Saint Cloud State University, Department of Human Relations and Multicultural

Education.

Purpose: Participants will learn about income distribution in a market economy and understand how finances affect access to education, health care and other factors by preparing and following a budget, engaging in problem solving, and reflective writing.

Materials: Printed copy of the family profiles (one profile is provided for each small group of four-to-six participants)

URL: http://www.tolerance.org/images/teach/activities/tt_family_profiles.pdf

Note: Income levels of the families are based on data from the 2000 census as well as a recent occupational salary survey. The income levels of the families essentially represent median incomes in the different income quintiles and are "typical" for the occupations described. It is important to note that none of the families meet official definitions of "poor" or "marginally poor." As a result, they do not qualify for any social services.

Printed copies of budget costs (one for each small group)

URL: http://www.tolerance.org/images/teach/activities/tt_budget_costs.pdf

Printed "Life Happens" sheets, cut into cards and placed in a basket

URL: http://www.tolerance.org/images/teach/activities/tt_life_happens.pdf

Paper or notebooks for student journaling

1. Introduce the lesson objectives to the participants. Divide your group into smaller, diverse groups and assign to each group one of the provided family profiles. Explain that each of these families is dedicated to providing their children with 1) basic necessities, 2) the best education possible, 3) health care, and 4) fun time.

2. During the first period, each group should construct a monthly budget for its family, using the budget cost sheets. Ask participants to reflect on the difficulty or ease of creating the budget in their journals.

3. During the second, third and fourth periods, ask each group to draw a "Life Happens" card from the basket. Small groups should then rearrange their budgets, making difficult decisions, as necessary. Ask participants to reflect on the difficulty or ease of creating the revised budget in their journals.

4. During final period, discuss groups' experiences as a whole class:

!

What did your family experience during the activity?

!

How did the families' financial situations change?

!

How were the families' experiences the same? How were they different?

!

How did wealth affect families' ability to withstand the "Life Happens" moments?

!

How did wealth affect families' abilities to provide 1) basic necessities, 2) the best education possible for their children, 3) healthcare, and 4) fun time?

5. Allow participants a final opportunity to reflect on their experiences with this lesson as a take-home activity. Collect journals for assessment.

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APPENDICES

Appendix A: Suggestions and Resources for English Language Learners

Appendix B: Icebreakers/Energizers for Any Session

Appendix C: Activity Ideas for Any Session

Appendix D: Episode Viewing Sheet

Appendix E: Culminating Experience Project Suggestions

Appendix F: Additional Resources from the California Newsreel

Appendix G: Boston-based Health Equity Resources

Appendix H: Health Agencies, Federal, State and Local

Appendix I: Glossary of Terms

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Appendix A: Suggestions and Resources for English Language

Learners (ELL)

Instructional Strategies

Eliciting Prior Knowledge – Have a discussion with participants before beginning the core of the lesson to elicit prior knowledge and set context. Participants are more likely to share if discussions are conducted with small groups, in a comfortable and positive setting. Conduct the discussions in English and the first language, if possible. Affirm that ideas from people with diverse backgrounds are valued. If a student is reticent about speaking, give them an opportunity to demonstrate his/her comprehension and knowledge through body actions, drawing pictures, or pointing at words/objects.

Word Splash – A collection of key terms or concepts. The terms selected represent important ideas that the teacher wants the participants to attend to, but initially the participants’ task is to make predictive statements about how each of the terms relate to the topic or main focus. Often the terms/words selected are familiar vocabulary for participants. The novelty of the vocabulary is the way in which the terms are associated with the new topic.

Display selected terms randomly and at angles on a visual. Participants brainstorm and generate complete statements (not just words/phrases) which predict the relationship between each term and the broader topic. Once participants have generated statements for each term they can check for accuracy of their predictive statements and revise where needed. This is a great technique prior to viewing a film. Just pause the film periodically for participants to discuss/revise predictions.

You can also create a “picture splash.” Another use is to have participants create their own Word Splash of what they consider key terms after they have viewed a film.

Think – Pair – Share – Have participants in small groups share back one thing they learned or one thought from watching the viedos. This is an activity designed for participants to share their individual ideas and build a synergy from the sharing of ideas.

Participants who may not feel confident sharing with a larger group are more likely to share with a smaller group.

Participants form into small groups. Each group should first select a recorder to scribe and a reporter who will share their response. Group is presented with the task. Each person has time to write his or her individual thoughts/responses. Then each member of the group shares their thoughts. The group will then discuss similarities/differences and come to some level of agreement as to how they will respond. The reporter from each group shares with the larger group, leading to deeper discussion about the topic/s.

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Easy as Pie Lesson Modification – Increase comprehension, interaction and higherlevel thinking skills using Teach the Text Backwards: o Do application/s: increases relevance and elicits prior knowledge o Discuss Main Points: use oral language, hands on o Examine Key/Study Questions: provides overview and identifies key concepts o Read Text/view film: Content should now be manageable for participants

Graphic Organizers – This is a diagram (i.e Venn diagram, flow charts, graphs) that represents the relationships of ideas or information from a source. .

Graphic organizers help participants to: o Attend to and isolate important information o Organize information into coherent structure o Integrate information and see relationships between concepts and elements o Capitalize on visual learning o Become a vehicle for teaching and thinking skills

Teacher can use graphic organizers to:

!

To activate current knowledge

!

To present new information or explain concepts

!

To take notes while listening, reading, or viewing

!

To organize and summarize information

!

To assess student learning

What’s Easy/What’s Hard? for English Language Learners

Easy

High interest, low vocabulary

Visuals

Role-playing

Labeling

Journal writing

Illustration/Drawing

Timelines with visuals

Hands-on actual experience

Social/conversational language

Hard

Idioms and Slang

Dialects

Following instructions

Organizing and analyzing data

Charts, maps, graphs, tables

Scientific vocabulary

Abstract ideas

Open-ended questions

Academic language

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Tips:

!

Increase wait time for responses

!

Respond to the message

!

Simplify your language

!

Demonstrate

!

Pair participants with native speakers

Resources

“Enriching Content Classes for Secondary ESOL Participants – Study Guide” Judith H.

Jameson, Delta Systems Co., Inc.

“Serving English Language Learners in High School” NABE News, Volume 25, Issue

No. 3 January/February 2002

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Appendix B: Icebreakers/Energizers of Any Sessions

These short activities can be used both as an introduction to and right after a viewing an episode or segment.

A. Step UP if… :

Purpose: Participants will be able to learn more about each other through identifying points of commonality and difference in their own experiences. Participants will have an opportunity to reflect on their personal experiences and how they are connected to the issues discussed in the film.

Optional Materials: List of prepared questions that are associated around a specific theme such as class, privilege, discrimination, opportunity, or around more general ideas

1. Tell participants that you will be asking a series of questions, or statements, and if the statement or question applies to them, have them move to a predetermined side of the room, if not, move to another pre-determined side of the room. (This can either be a step back and step forward, or opposite sides of the room pre-labeled “yes” and “no”)

2. Tell them that some of these questions will be more intense than others, and there is to be no speaking or commenting during the activity. Observe who moves for where, and pay attention to how this makes them feel.

3. Ask the questions, starting with less intense, moving towards some more intense questions.

Possible questions: a. Less Intense i. Who can identify with something we’ve seen on the video? ii. If you’ve been afraid to go to school or be in school because of violence or harassment? iii. Has themselves or has someone close with diabetes? b. More intense i. Has witnessed violence, first hand? ii. Been a victim of violence? iii. Ever been on food stamps? iv. Lost a relative or close friend during your life time?

Questions to use after a viewing to get a sense of participant reactions: a. If you learned something new. b. If you saw or heard something that was a review for you. c. If you could identify with an issue or problem people in the video were struggling with. d. If you heard a word or a phrase repeated a lot of times. e. Themes or issues that were repeated from other discussions or episodes.

4. Invite participants to come up with their own to finish off the activity.

5. Process questions: a. What did you observe while we were going through the questions?

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot b. How did it feel to be one of the only people standing on one side or the other? c. How did it feel/what did you think when you were on the “Yes” side with at least a handful of other people? d. Where their things that surprised you? e. What did this activity show us? f. Did this bring to mind, or emphasize issues we should be focusing on? g. Does this change our ideas on how approach issues we face individually?

Is it solely our job to fix our own problems, or is there a better way?

Variation : Change the commands to, “stand up if…”, “sit down if…”, “raise your hands if…”, “or jump up one time if...”

Facilitator’s Notes:

1. Depending on the questions asked, or how far away the participants are asked to stand, this can be a moderate to high risk activity. This is best used after viewing an episode or segment. The idea is for this activity to go quickly. The first few questions will take the participants a bit to stand up, but as the activity goes on, and they are paying more attention and are more awake, it will be possible to ask the questions earlier.

The facilitator should also participate in the activity. Activity should be done after a few sessions, so the participants feel comfortable.

2. Have youth develop their own questions or pose your own.

B. Strike a Pose

Purpose: Participants will use their creativity towards exploring what they thought about an issue or episode.

1. Instruct participants that they are going to be walking around for a bit, and when you say freeze, stop walking and you are going to give them an emotion/role/problem, and they have to shape their bodies into some creative form according to how that makes them feel/what it makes them think of. For a few of these we are going to ask people to explain their pose, for others, we will just take a few seconds to allow people to look at other poses.

2. OPTIONAL: split people up into groups A and B so that you can have two emotions/parts at once.

3. Start to have people walk around the room.

4. Every ten seconds or so, say, “Freeze” and state and emotion, describe a situation.

Possible emotions/parts: a. Group A: You are the family member of a hospital CEO, Group B: You are the janitor of the hospital. b. You are all successful, female, lawyers, earning top wage, living in top communities. Group A: You are an African American Female that has been experiencing racism all her life and just gave birth to a premature

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot baby. Group B: You are a white female that just came back from the hospital having given birth to a completely healthy baby. c. You are all immigrants who just moved to the United States d. You are all immigrant teenagers who moved to the United States when you were three, remember very little about home town, and have not been able to visit birth country since moving here.

5. Process questions: a. Where any of these positions particularly hard to create a pose for? b. What did you observe? c. Anything this made you thought of that had not occurred to you before? d. Why did we do this activity?

C. Three Chair Improv, from Pollack, Stanley, Moving Beyond Icebreakers: An

Innovative Approach to Group Facilitation, Learning, and Action. The Center for Teen

Empowerment, Inc. 2005.

Purpose: Creativity, Acting, Surfacing Group Dynamics

Set up three chairs in the front of the room and label each with a sheet of paper taped to the back of the chairs that will tell the person sitting in the chair something about how to act. The labels can be roles or they can be emotions. For example:

$

Teacher, student, administrator

$

$

$

$

Police, youth, resident

Having fun at a party, about to have a fight, a peacemaker

Afraid, happy, hostile

Bored, angry, joyful

In addition, you can create a situation for three people to act out.

1. Ask for two volunteers to come to the front of the room and sit next to each other,

2. If you have created a sketch of a scene, tell this to the group and the actors.

Otherwise, tell the actors to improvise the scene themselves.

3. Tell the actors to play the role or emotion stated on the label, and let them to improvise for at least thirty seconds.

4. Give a signal to the group that someone should volunteer to sit in the third chair and join the scene. The new actor must take the role labeled on the third chair and join the scene that is in progress.

5. Tell the group that every 30 seconds or so, someone from the group should come up to take the “new person” chair (where the third actor is sitting). The actors must shift over one place, and the original actor who was sitting on the end must leave the scene. The scene continues, but the actors take the new roles that are assigned to the chair they are now sitting in.

6. Let this process continue for several rounds. Each new person who enters the scene always enters from the same side and takes the “new person” chair, while the other actors move down chairs in the same direction.

Processing suggestions:

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In addition to looking at the content of the scenes that developed, you can consider these issues in processing:

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$

Changing roles within the group

Making room for new ideas

$

$

Being able to adapt new situations and changing situations

Making things up as you go along

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How different people interpreted roles or the emotions

Additional Icebreaker/Energizer Resources:

Moving Beyond Icebreakers: An Innovative Approach to Group Facilitation, Learning, and Action. Stanley Pollock (Author) and Mary Fusoni (Contributor). 2005

For more information check out: http://www.movingbeyondicebreakers.org/

Growing Together: Techniques for Building Inspired, Diverse and Productive

Communities. Greg Gale.

For more information check out: www.thefoodproject.org

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Appendix C: Activity Ideas for Any Session

The following activities can be used for any session. Activities range from A-T.

A. Journal Reflection

Information covered through the series can stir up a range of emotions that can be shocking, affirming and frustrating for viewers. This activity is designed for participants to share and reflect on and channel their immediate reactions to viewing an episode.

Materials: Journals/notebooks

Participants can journal their responses to the questions:

# What were your feelings when you were viewing the film?

# What did you see in the film?

# Describe your reaction to the film in one word or a phrase.

# Do you feel that there were any important messages for you in this film?

# What is one question you have?

# Did you feel that the film expanded your understanding of health and factors that shape our health?

The group can decide to share their responses or reflect privately.

Variation: Use Key Discussion Questions as journaling activity.

B. Participant led debriefing questions

Purpose: Participants will think critically about the episode and develop their own questions to use in leading small and larger group discussion. Use directly after viewing any episode as a discussion starter.

1. Before watching the episode: Prompt the participants to write up one question they would like to ask the rest of the group while they are watching the video.

2. Have in a large group, 2-3 of the participants ask their questions to the larger group.

Have other participants respond to the question. Before moving on to the next question, ask participants if the issue is clearer.

Variation: Provide comprehension and discussion questions included in this guide to participants and have them select ones they would like to ask the larger group.

C. Special Guests

As a way for participants to connect what they see in the episodes to what is happening on the ground around them, invite a special guest whose life or work connects to some of the issues discussed in the series.

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Invite a local policy maker, community or youth leader to come and join a viewing and share their reactions and thoughts for action and/or facilitate the dialogue using comprehension or discussion questions provided.

Watch an episode and have participants prepare questions ahead of time before meeting with an invited guest whose work relates to the episode.

D. Think, Pair and Share

Purpose: This is an activity designed for participants to share their individual ideas and build a synergy from the sharing of ideas. Participants who may not feel confident sharing with a larger group are more likely to share with a smaller group.

Materials: Room for participants to meet in small groups, with flipcharts and markers for scribing. It is also helpful to have an adult facilitator at each table.

1. Have participants form into small groups. Present each group with one Key

Question to answer. Groups can be given different questions or the same question.

2. Each group should first select a recorder to scribe and a reporter who will share their response. After a question is read aloud to group, each person has three/four minutes to write their individual thoughts/responses. Then each member of the group shares their thoughts. The group will then discuss similarities/differences and come to some level of agreement as to how they will respond.

3. Report back: The reporter from each group shares with the larger group, which can lead to deeper discussion about the topic/s and/or prompt an essay topic.

E. Success Stories

Tie each viewing and discussion to a “What can you do” and “Success stories” discussion around local heroes and/or local work being done to improve health and social conditions. Have participant’s research an example of the positive use of power in their community or City making a one-page case story, photo, video, or oral documentary project to share with the rest of the group. Methods for creating the case story can include but not be limited to internet searches, key informant interviews with neighborhood or City leaders, residents, and organizations.

F. Taking Action

Purpose: This activity is designed for participants to share and reflect on their immediate reactions to viewing any segment, and what actions steps they would suggest for these communities as they struggle with unhealthy institutional policies.

Materials: markers, chart paper

1. Post 4 posters around the room, each with one of the questions listed below.

2. Assign participants into 4 pairs or small groups.

3. Distribute markers to each pair/group.

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4. Read each chart question (1 question/chart):

# What were your feelings when you were viewing the film?

# Can you describe your reaction to the film in one word or a phrase?

# Do you feel that there were any important messages for you in this film?

# Did you feel that the film expanded your understanding of health disparities?

5. Assign each group one of the four questions. Ask participants in each group to

write their answers to their group’s question on their chart paper.

6. Ask the participants in each group to compare their cards for similarities and

positive/negative language and to describe what would be necessary to reverse

the negative feelings.

7. Ask each group to select someone to report back to the rest of the participants.

G. Chain of Action

Have participants write down/draw one or two things they would like to do to take action on a piece of paper. Tape ideas together to create a visible “Chain of Action”.

H. News Cast

( 50-60 minutes for a class of about 20- 30, less time if done as homework)

Purpose: To have participants apply what they are learning to real life, relevant and current and local issues in the news in an active and interactive way

Materials : A handful of short news paper articles on issues that demonstrate social influences on health. See Unnatural Causes websites at www.unnaturalcauses.org

and look at local newspaper listings on-line. A few suggestions are below.

People in debt feel literal pain. AP. Boston Globe. 2008. http://www.boston.com/news/health/articles/2008/06/10/people_in_debt_feel_literal_pai n_poll_says/

How Racism hurts literally.

Drexler, M. Boston Globe. 2007. http://www.boston.com/news/globe/ideas/articles/2007/07/15/how_racism_hurts____lite rally/

1. Break participants up into groups of 4-5 participants

2. Give each group 4-5 copies of one of the articles that is relevant to an Unnatural

Causes episode, or theme.

3. Give each group 10 – 15 minutes to come up with a news casting covering the issue. All group members must present some part of the issue in some way.

Help them brainstorm different roles, or give them some possible roles if short on time. Examples of roles include: a. Main newscaster b. News room interviewer c. Individual from the article, or directly connected to issue d. Indirectly effected individuals, community members giving their take on the issue. e. Public health experts to talk as an “expert opinion”

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4. Tell participants they must include a. A personal story b. An overview of the article and the issue c. How this connects to issues that we have been talking about d. What social determinants are involved in this situation e. How we can work together to avoid future incidences of the issue

5. Give each group 5- 10 minutes to present, and then 2 minutes for individuals to ask questions about the issue, or what has said.

6. Debrief with some of the following questions: a. Draw a horizontal line on the board, label one end directly related to health issue, and the other, indirectly related to health issues. Ask the participants where they would place the various article stories on the line. b. Was there anything or any aspect of the stories that people did not realize could be seen as a health issue? c. More questions about how each article relate to health issues?

Facilitator’s Note: Should be done with participants after they are a little familiar with the themes and social determinants.

I. Health and Society Article

Purpose: This activity is to get participants to connect the events happening in their neighborhood/city/state that connect to the issues that they are learning about, and broadening their ideas about where these problems surface.

Materials: At least one news paper article from local news paper covering an issue related to the videos. Article Resources:

People in debt feel literal pain. AP. Boston Globe. 2008. http://www.boston.com/news/health/articles/2008/06/10/people_in_debt_feel_literal_pai n_poll_says/

How Racism hurts literally.

Drexler, M. Boston Globe. 2007. http://www.boston.com/news/globe/ideas/articles/2007/07/15/how_racism_hurts____lite rally/

1. Give out the article as a homework assignment.

2. Next class, work the discussion of the article into the discussion of the video series or class session.

Possible Discussion questions: a. What was the article about? b. Why do you think this article was assigned in conjunction with this class? c. Are there specific video’s this article reminded you of? Specific issues, or moments within the episodes? d. What were the social determinants involved in this article? e. What do you think individuals can do to help themselves avoid the negative consequences of this issue? What can communities do?

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot f. What can you, as an individual do to start these community wide solutions?

Facilitator Note: Best to be used as a homework assignment, but this activity can be altered in many ways to best suit the needs and personalities of your class.

J. Advocacy Role Play

Purpose: This activity gives participants a chance to practice advocating for community health and social justice issues.

Optional materials : Internet access, computer, projector

1. Split participants into groups of four or five.

2. Give each group a scenario that relates to an issue that is of growing public health concern. This scenario may relate to a health outcome, such as an increase in the rate of Type II diabetes, or a social, economic, or political factor that affects health such as deteriorating housing or home foreclosures. You may provide examples ahead of time or allow the group to choose a problem or problems that most relates to them. See some brief examples below: a. A rise in incidents of youth violence in the school they attend. b. Several of their siblings, close friends, and more of their fellow community members (neighbors, church members) have asthma. c. More friends’ family members have Type II diabetes in younger as well as older populations. d. Tell participants will be responsible to present their problem or issue to an audience they think that can address their problem. The presentation format may vary depending on the setting you may want participants to provide presentation in a Powerpoint or other visual format to a class or in front of a pre-determined panel of community residents, leaders, or

“experts”.

3. Provide participants with the following questions to help them craft their presentation. a. What is the issue?

-If the issue is NOT a health outcome, how does the issue relate to health?

-If the issue is a health outcome, how does it impact social, economic and/or political side of things? b. Who is affected by the issue? c. How are they affected by the issue? d. Who is responsible for the issue? e. What needs to change for the issue to be resolved? f. Who needs to be a part of resolving the issue and why?

4. Give participants time to come up with a presentation. All participants in the group must be a part of the presentation. Tell them that presentations must include: a. Overview if the issue b. Personal stories describing the issue describing who is affected and how

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot c. Clear “ask” of what the group would like to see change and how d. How the “ask” will help out those affected in the short term, and in the future.

5. Give each group 5 – 10 minutes to present their presentation.

6. After the presentation, there will be 2 minutes for a question answer section.

7. Debrief with some of the following questions: a. Were any of the problems similar? b. Any of the suggested solutions or asks similar? c. Can you see any of these asks working for problems in your community d. Were the “what the community is doing” realistic? What else could the communities do to help themselves for each of the scenarios? e. What are the possible roles that individuals play in this advocacy process?

What role can you see yourself playing in this process?

Facilitator’s Note: This activity can be also be used to prepare participants for an in person meeting with policymakers, city councilors or community leaders. Tie this activity to larger conversation around the policy advocacy process. You may also require participants do background research to frame their issue and provided data and other sources to back up their arguments.

K. A Great Debate

Purpose: Participants will think through problems in their communities, practice building solutions and working with community organizing barriers.

1. Give or have participants come up with a controversial issue that relates to a health topic or a factor that affects health such as housing (in this case a controversial issue could be mixed income vs. low –income housing development).

2. Break participants into smaller groups and assign each group the following roles for a debate around the issue: The moderators, The advocates, the opponents, etc. You can also brainstorm with participants the various roles that come up around a controversial issue and assign groups or individuals accordingly.

3. Have each group take 10-15 minutes to prepare a two-minute opening argument with clear points on where they stand on the issue with the exception of the moderators. Have the moderators develop questions and the time limit to respond for all groups.

4. Have each group take turns presenting their two-minute opening argument.

5. Next have the moderators ask the first question to one of the groups. Once the group answers in the allotted time moderators should ask the other group if they would like to rebut the argument/answer.

6. Debrief the activity.

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L. Developing a Public Service Announcement (PSA) (20-25 mins.)

Purpose: This activity will allow participants to integrate concepts related to health

disparities and health equity examined throughout the session by developing a

media advisory.

Materials: Access to the internet (optional)

1. As individuals or in small groups, have participants develop a media advisory about an issue of interest raised in an episode. You may also direct participants that their advisory will be part of a public awareness campaign about health and social justice.

Allow participants to use the internet to conduct brief research if needed.

Participants; advisory should be no longer than 2 minutes long and the advisory can be visual (i.e. photos, posters), oral (radio public service advisory, poem) or a blend.

2. Have participants share their advisory back to the larger group.


$

Identify a local media outlet such as public radio station or local public access

$ programming and have youth share their message on these outlets.

Write an op-ed for a local or neighborhood newspaper.

M. Art Gallery (20-25 minutes)

Purpose: This is an activity designed to set the context for the discussion.

Participants also get a chance to share their knowledge in a risk-free manner that reinforces prior knowledge.

Materials: Chart Paper and markers

1. Place one key vocabulary word or phrase from the episode on chart paper. Place five or more chart paper on walls around the room each with a different key vocabulary word. To save time set up chart paper around the room before viewing the episode.

2. Have participants circulate in small groups and write down on the chart paper what they know/think they know about this word/phrase. Groups should circulate until they return to where they started. Each group will have a chance to share and edit their knowledge, as well as view information from each of the other groups.

3. Select one volunteer to read-out each area for the whole group. Questions generated can be used to organize and focus the discussion after viewing the episode.


# What connections do we see between these words and how we’ve defined/described them?

# Are there any words that jumped out at you? Why?

# Were any of the words new for you or ones that you have heard before? Which ones?

# Do you think any of these connect or relate to health? How do you think they do or don’t?

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Facilitator’s note: This activity can be used before or after viewing the episode. If

used before viewing have participants free associate ideas or thoughts with key

vocabulary words and then revisit and add additional thoughts that may have been

triggered from watching the episode.

N. Word Fun (15-20 minutes)

Purpose: This activity helps participants learn the vocabulary words that are used in the episode, and should give them a better understanding of how to use these words in context.

Materials: Key session vocabulary

1. As individuals or in small groups, give participants a list of vocabulary words from

Episode 5 with definitions. Divide participants into groups and have them develop a poem/rap/rhyme that uses the 5 words. Then have participants perform their poem/rap/rhyme.

Facilitator’s Note: To extend the duration of this activity, give the list of vocabulary words without the definitions and ask each participant to define the words in their own words. Then, select a sample of participants to share their definitions with the group and discuss. The facilitator then discusses each individuals’/groups’ definitions and shares the definitions from this guide with the group. Then, follow Step 1 above.

O.

Headlines at Six (15-20 mins.)

Purpose: This activity is for participants to practice their critical thinking, organizational, and public speaking skills.

Materials: Chart paper, markers, and/or access to a computer with Microsoft (c)

Power Point and an LCD projector.

1. As individuals or in groups, ask them to develop a two-minute headline news story for

“Bad Sugar”. Instruct participants to share that they will need to make sure they cover the 5 W’s: Who, What, When, Where and Why. Depending on time, participants can select to either develop the story and report back to the group, or to create posters/other visual representations to share with everyone. Participants working in groups can take on the roles of the various people who are being interviewed for the story.

2. Have each individual or group share their report in front of the group, giving each group 2 minutes to present.

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P. Write a Letter to a Policy Maker (30- 60 mins.)

Purpose: This activity has participants identify potential concerns and advocate for them.

Materials: Paper, list with names and addresses of local and state policy makers

1. Have participants write out a brainstorming list of things that are challenges to their communities.

2. The participants should then use that list to write a formal, yet hypothetical letter to their policy maker about what the issues are, their importance/impact on community health, and what solutions they are advocating. Provide a printed example.

3. Next, ask the participants to share their letters and for the group to provide feedback

to strengthen their arguments and recommended solutions.

4. At home, have the participants rewrite their letters based upon the group feedback

and ask them to mail them to their policy makers. Or have participants bring letters

back for next session, provide postage if possible, and do one large mailing.

Q.

Root Cause: The Problem Tree (20-30 minutes)

Purpose: Participants will identify a health issue that is most meaningful to them and identify the root causes and effects of the health issue.

Materials: Chart/facilitator paper with drawing of tree with multiple branches and roots with following labeled: Roots= Causes, Leaves, Branches=Effects,

Trunk=Problem

3. Have participants brainstorm health issues or problem that they feel are most important to them, their families, or general population. Do not worry if it seems like a broad topic because the problem tree will help break it down. The problem or issue is written in the centre of the tree and becomes the 'trunk' of the tree. This becomes the 'focal problem'. The wording does not need to be exact as the roots and branches will further define it, but it should describe an actual issue that everyone feels passionately about.

4. Next, the group identify the causes of the focal problem - these become the roots and then identify the consequences, which become the branches. These causes and consequences can also be created on post-it notes or cards, perhaps individually or in pairs, so that they can be arranged.

5. Once causes and effects are written down or posted on tree ask the following questions:

# Does this represent your reality? Are all factors including the economic, political and social dimensions to the problem considered?

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# Which causes and consequences are getting better, which are getting worse and which are staying the same?

# What are the most serious consequences for you? Which are of most concern to you?

# What criteria are important to you in thinking about the best way to address the problem?

# Which causes are easiest / most difficult to address? What possible solutions or options might there be??

# What do YOU think would make the most impact to focus on?

# What approach/method would you use to solve the consequences of the problem?

# What approach/method would you use to solve the root causes of the problem?

# What would happen if you focused only on finding solutions to the consequences of the problem?

Variation:

1. In small groups or as large group, draw two trees, one that is strong and healthy, representing a “healthy community” and another that is stunted representing an

“unhealthy community.”

2. Have participants highlight poor health outcomes for each recognizing that both have health challenges, the difference being the percentage of people having poorer health is greater for an “unhealthy community”.

3. Next for both communities have participants identify the root causes for the poor health outcomes in the healthy and unhealthy communities, prompt participants to think about the social determinants of health including housing, education and employment.

4. Look for distinctions, in the root causes highlighting larger social, economic and racial injustice affecting “unhealthy communities” as the health inequity.


!

If both communities have poor health outcomes is there an issue?

!

Who might the health community and unhealthy community represent?

!

Who might be responsible for the differences we see between the health and unhealthy community?

!

Do you think that both communities have strengths and weaknesses? If so, what might they be?

Facilitator’s Note: Acknowledge to participants that this activity plays on generalizations and is used to illustrate the meaning of health equity.

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R. Strength Tree, a Community Assets Approach (Complimentary to Problem

Tree) Adapted from: Gubbles, Peter and Koss, Gatheryn. From the Roots Up:

Strengthening Organizational Capacity through Guided Self-Assessment. World

Neighbors, 4127 NW 122 nd Street Oklahoma City, Oklahoma. www.wn.org

pages 164 –

165.

Purpose: This activity gives participants an opportunity to explore strengths of their

community, and think through the impacts these strengths can have.

Materials: Facilitator paper, markers

1. Split the class up into groups of 4-5 participants, give each student a newsprint sheet, and 4-5 markers.

2. Introduce that this activity will focus on the strengths of their community

(community as in area in which they live, a group they are a part of, or as in the community of youth participants. Either the instructor can assign one, or give each group a different sub community to focus on, or give the participants the option to pick their own).

3. Explain that they will create a metaphorical map of their community’s strengths as a “tree diagram”. Pick an example community (perhaps the school or organization the class is a part of), and have the participants brainstorm strengths.

4. Draw a tree on the blackboard, and label the following parts of the tree as the following categories: a. Roots = Capacities (activities the community does successfully, such as

“able to plan meetings”, “able to stay focused on main objective”) b. Trunk = strengths (for example, strong connections to larger community) c. Branches/leaves = Results (for example, more people becoming involved in solution to the problem and volunteering) d. Fruits = impacts (solution is mobilized because people are working on it) e. Sky = external forces (government spending on public interests and community projects)

Note: To make activity less complicated, make the roots = strengths, branches = results and fruits = visible change, leaving out other aspects.

5. Give them 20-30 minutes to work on their own tree.

6. Have them share with the class and have the class comment, or add more parts to the tree.

7. Discussion: a. Do we notice similarities or differences between trees? b. Now take one of the problems, put it against the trees, and see how one can affect the other… (Review some of the problems discussed frequently in class), what can we see as possibilities?

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OPTION 1 = if Problem Tree exercise was done, give each group one of those trees, and have them try to connect how the Strength Tree could work against the Problem

Tree

OPTION 2 = Give each group (or combine groups to go faster), a problem that has been discussed, and have them act out a debate between the Strength Tree, and the

Problem. Give them 5-10 minutes to prepare, and then have the rest of the class act as judges. Afterwards ask the different groups how that felt, and who they thought won, then ask the audience who they thought won, and points that each side might have missed.

S.

Problem Prioritizing (10-20 minutes)

1. Split participants into groups of 4-5 . Give each participant 4-5 index cards. Have them write on each one, one of the following:

$

Housing

$

$

$

$

$

$

$

$

$

$

Education

Laws/Policies

Job/Employment

Racism/Discrimination

Neighborhood

Wealth

Transportation

Behavior: Eating, Physical Activity/Exercise

Friends, family, community

Biology/Genetics

2. In groups, have them each order them by what they think influences their health most, then have them come together as a group and agree on an order. Compare orders with the other groups. Discuss as large group observations.

Variation: Write the following on a board and take a group tally, allowing each person to select their top three choices that they think most affect health.

Facilitator’s Note: Use this before viewing an episode, record responses and then do again after viewing episode to see if there is a change in ordering.

T. Making Unhealthy Neighborhoods Healthy (20-25 minutes)

Purpose: This activity is designed to have participants think critically and creatively

about their neighborhoods to identify health hazards and health resources and

propose changes.

Materials: Chart paper and markers

1. Divide participants into groups or do as one large group. If in groups, give each group a blank sheet of paper and marker. Have participants/group list or draw 5

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot ways in which their neighborhood is unhealthy and 5 ways that it is healthy. Have each group show what they have come up with, and share with the rest of the class.

2. Next have participants in groups or individually come up with one idea to make the unhealthy aspect of their neighborhood healthy. (Note: if time runs out have participants do as homework/ out of program time activity)

Facilitator note: Use this activity in conjunction with Mapping Community Assets .

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Appendix D: Episode Viewing Sheets

This sheet can be helpful in terms of gauging participant reactions and comprehension.

Hand out before the episode viewing and have participants share what they wrote down or collect as assessment.

Name____________________________________ Date______

Episode title:

3. I saw………………

2. I heard………….

3. I felt……………..

4. Questions I have………..

5. New words and vocabulary I learned……….

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Appendix E: Culminating Experience Project Suggestions

A. Multimedia project using Photovoice , Oral Key Informant Interviews and

Video- Assign or have participants select a particular health disparity issue to focus

on for the duration of the program. Examples of issues to focus on can include: Teen

Pregnancy, Youth Violence, Youth Asthma, Infant Mortality, Obesity, Diabetes. Have

participants identify the health disparity and document through photos, essay writing,

oral key informant interviews or other media, the social and economic factors that

contribute to the disparity, how the community is affected, the resources and positive

or hopeful aspects that exist within and/or outside the community to address the

disparity. Create a poster presentation, portfolio, slide show, power point presentation, or some sort of visual representation.

B. Organize a community, parent or peer viewing- Use the Unnatural Causes

Toolkit to develop a community, parent or peer viewing. Youth participants can

select the episode or segment, develop questions, an agenda and lead outreach.

5. Theater Performance Have participants develop a theater or improv performance about health, where they discuss the factors and root causes contributing to

differences in health and propose solutions to the audience to combat them.

D. Advocacy for Action- Throughout the course of viewing the episodes have

participants work on identifying the social and economic factors that are affecting

their community’s health and well-being i.e. CORI, housing conditions, environmental

air quality, violence, etc.). Have participants collect background

information to frame their argument on an important social issue affecting their

community’s health. Have participants identify the issue, who is affected, and who

can change the situation and how. Have participants identify different stakeholders to

form a panel that will inform how the issue affects community health and well being.

Hold a hearing with local policymakers to share the panel’s testimony.

E. Field trip Organize an informational field trip to a local hospital, public health program, city agency such as Parks and Recreation, Transportation, or

Development, State House, etc. Have participants prepare questions ahead of time based on what they have viewed throughout the episodes to ask representatives about how their work relates to health.

F. Job shadowing- Contact local agencies including healthcare and public health institutions, city agencies, public policy organizations and offices opportunity to set up job shadowing opportunity for participants to learn hands-on about different fields related to health and health equity.

G. Develop Health Equity Brochure or Directory for Community - Present this idea as a culminating part of the course, semester, or program where participants will develop a Heath Equity Brochure/Directory for their community. Components of such as brochure could include an awareness piece that discusses why health is about

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot more than healthcare and key community/local resources, coalitions or campaigns related to social determinants of health, i.e. education, employment, housing, food access. If there is capacity, have participants translate into languages specific to the community. This project may require access to Microsoft Publisher, Powerpoint and other applications. See if there is a Media Lab available on site and whether it can be possible to partner on this project.

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Appendix F: Additional Resources From the California Newsreel

Additional Unnatural Causes Series Resources from the California Newsreel

The following guides below have been developed by the California Newsreel and national partners. Facilitators using the Guide are recommended to view the website and browse the materials to become familiar with the subject matter conveyed through the documentary.

1. Discussion Guide - The Discussion Guide contains suggested pre- and post-viewing activities, comprehension and discussion questions for each program, and practical follow-up actions for participants. Access the guide at: http://www.unnaturalcauses.org/discussion_guides.php

2. Policy Guide – The policy guide presents a menu of ideas - many of which are a commonplace in other countries - and a list of key organizations working to advance related issues. Access the guide at: http://www.unnaturalcauses.org/policy_guide.php

3. Action Toolkit - This toolkit provides facilitation tips, background, sample agendas, and guidelines for planning an effective screening – one that not only deepens understanding of issues but serves as a step towards further involvement. While geared more towards older learners, younger learners can still benefit from these resources. the toolkit at: http://www.unnaturalcauses.org/download_toolkit.php

4. Health Equity Database This database contains articles, Web sites, video clips, chart and data, interviews, transcripts, interactivities, case studies, and educational and outreach materials. Topics are the following: Childhood/Early Life, Chronic Stress,

Education, Food Security, Genetics, Jobs & Work, Housing/Neighborhoods, Income &

Wealth, Race/Racism, and Social Inclusion. Check back often as resources will be added on a regular basis. Access the database at: http://www.unnaturalcauses.org/resources.php

Creating S.M.A.R.T. Objectives http://www.rapidbi.com/created/WriteSMARTobjectives.html)

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Appendix E: Boston Based Health Equity Resources

A. Health Care and Public Health

Boston Public Health Commission , http://www.bphc.org

Boston Community Health Centers , http://www.massleague.org/AboutTheLeague.htm

Massachusetts Department of Public Health, http://www.mass.gov/dph

The Medical Foundation, http://tmfnet.org

B. Social Justice and Social Change

City School , http://www.thecityschool.org

Community Change, Inc.

, http://www.communitychangeinc.org

The Food Project , http://www.thefoodproject.org

United for A Fair Economy , http://www.faireconomy.org

The Jamaica Plain Forum, http://jamaicaplainforum.org

C. Youth Development and Organizing

CCHERS Community Voices , http://www.cchers.org/

City School , http://www.thecityschool.org/

The Civic Education Project , http://www.civicedproject.org/

The Food Project , http://www.thefoodproject.org/

Hispanic Office for Planning and Evaluation (HOPE) , http://www.hopemass.org/

Hyde Square Task Force , http://www.hydesquare.org/

Sociedad Latina , http://www.sociedadlatina.org/

Teen Empowerment , http://teenempowerment.com/

D. Faith Based

Greater Boston Interfaith Organization (GBIO), http://www.gbio.org/

Black Ministerial Alliance , http://www.bmaboston.org/

E. Housing and Tenant Organizing

Vida Urbana/City Life , http://clvu.mayfirst.org/

Union of Minority Neighborhoods , http://www.unionofminorityneighborhoods.org/

F. Food Security and Food Access

Boston Collaborative for Food and Fitness , http://www.masspreventioncenter.org/Food_and_Fitness/food_and_fitness.html

Community Servings , http://www.servings.org/

Project Bread , http://www.projectbread.org

The Food Project, http://www.thefoodproject.org/

Rosie’s Place , http://www.rosies.org

The Women’s Lunch Place , http://www.womenslunchplace.org/

G. Anti- Racism and Discrimination

Community Change, Inc.

, http://www.communitychangeinc.org/

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H. Violence Prevention

Boston Public Health Commission , http://www.bphc.org

Louis D. Brown Peace Institute , http://www.louisdbrownpeaceinstitute.org/

I. Labor

SEIU Local 615 , http://www.seiu615.org/

The Boston Workers Alliance, http://bwa.org

J. Environmental Justice

Alternatives for the Community Environment , http://www.ace-ej.org/

Action for Regional Equity, http://www.policylink.org/BostonAction

K. Community Economic Development

Dudley Street Initiative , URL: http://www.dsni.org/

Community Development Corporations , http://www.macdc.org/docs/aboutus.html

Boston ABCD , http://www.bostonabcd.org/

Union of Minority Neighborhoods, http://www.unionofminorityneighborhoods.org

L. Policy and Advocacy

Massachusetts Immigrant and Refugee Coalition , http://www.miracoalition.org/

United for a Fair Economy , http://www.faireconomy.org/

The Hyde Square Task Force, http://www.hydesquare.org/

Healthcare for All, http://www.healthareforallorg

Alternatives for the Community and Environment, ACE, http:www.ace-ej.org

M. Immigrant Rights

National Immigration Project , http://www.nationalimmigrationproject.org/

Greater Boston Legal Services , http://www.gbls.org/

Massachusetts Immigrant and Refugee Coalition , http://www.miracoalition.org/

Chelsea Collaborative, http://www.chelseacollab.org

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Appendix F: Federal, State and Local Health Agencies

93


We the people!

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Appendix G: Glossary of Terms

acculturation The process of adopting the cultural traits or social patterns of another group. affluent – Having an abundant supply of money, property or other possessions of value. Rich. biological determinant - Factors that influence health such as age and sex. Can also refer to bacteria and other micro-organisms that impact one’s health. capital- The wealth, whether in money or property, owned or employed in business by an individual, firm, corporation, etc.

chronic disease- Disease that lasts for a long time, is slow to develop and can get worse over time. Chronic diseases include: diabetes, cardiovascular or heart disease, stroke, asthma and cancer. They account for 70% of all death in U.S. and are preventable. See http://www.cdc.gov/nccdphp/ and http://www.who.int/topics/chronic_diseases/en/ for more information.

civic engagement- Can mean not only a set of actions and efforts, but a feeling of belonging, an experience of investment and ownership in the local, regional, national, and/or international political communities to which citizens belong. Civic engagement can also mean working to make a difference in the civic life of our communities and developing the combination of knowledge, skills, values and motivation to make that difference. It can take many forms including individual volunteerism to organizational involvement to electoral participation. It can include efforts to directly address an issue, work with others in a community to solve a problem or interact with the institutions of representative democracy. class A hierarchy or system of ranking individuals or groups that goes from powerful to powerless. In the U.S. many believe in three classes: the rich, the middle class and the poor. community empowerment - Based on the core concept of power, this is a social process that involves individuals acting collectively to gain greater influence and control over the determinants of health and the quality of life in their community, and is an important goal in community action for health and other issues. corporation- A body that is granted a charter recognizing it as a separate legal entity having its own rights, privileges, and liabilities distinct from those of its members.

cortisol- It is a vital hormone that is often referred to as the "stress hormone" as it is involved in the response to stress. It increases blood pressure, blood sugar levels and suppresses the immune system. culture- The behaviors and beliefs characteristic of a particular social, ethnic, or age

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot group: the youth culture; the drug culture. Anthropology: the sum total of ways of living built up by a group of human beings and transmitted from one generation to another. determinants of health - The range of personal, social, economic and environmental factors that determine the health status of individuals or populations. They can be grouped into seven broad categories: socio-economic environment; physical environments; early childhood development; personal health practices; individual capacity and coping skills; biology and genetic endowment; and health services. discrimination- An action based on pre-judgment in favor of or against a person, a group, an event, an idea, or a thing. displacement- To move something from its normal location or position. In the case of people, can be provoked as result of natural disaster (i.e Katrina Hurricane survivors) or by force (i.e Indigenous People’s in North America). dispossessed people- People deprived of possession such as land, cultural identity, or spirituality. Such peoples in the U.S. include Native Americans, African Americans, immigrants, refugees, among others.

economic environment - Factors in the economy, such as inflation, unemployment, interest rates, etc., that influence what people and organizations will want to and can afford to buy. empowerment - Process of transferring control over decisions and resources to those with less power. In communities, it may come from within or it may be supported from outside. epidemic- Affecting a large number of individuals in a community or group at the same time a term most often used in health but can be used to describe other social conditions as well i.e. poverty, hunger. environmental support- Those things in our physical and social environment, the environments where we live, that reinforce and support good health such as parks, maintained sidewalks, access to food resources etc. ethnicity - A social construct which divides people into distinct groups based on characteristics such as shared sense of group membership, values, behavioral patterns, languages, political and economic interests, history and ancestral geographical base.

fair trade -

Is an organized social movement and market-based approach to alleviating global poverty and promoting sustainability. The movement advocates the payment of a fair price as well as social and environmental standards in areas related to the production of a wide variety of goods. It focuses in particular on exports from developing countries to developed countries.

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot free trade -

Is a market model in which the trade of goods and services between or within countries flows unhindered by government-imposed restrictions, which may increase costs to goods and services, producers, businesses, and customers.

federal health agencies —Agencies with Federal authority to administer regulations that pertain to health, many of which fall under the U.S. Department of Health and

Human Services (HHS). These include: the Office of the Surgeon General, the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid

Services (CMS), and the Food and Drug Administration (FDA). genetics A discipline of biology, it is the study of how living things receive common traits from previous generations. These traits are described by the genetic information carried by a molecule called DNA. An organism’s DNA determines what a person will look like.. Every living thing on earth has DNA in its cells.

For interactive activity have participants check out: http://nobelprize.org/educational_games/medicine/dna_double_helix/index.html

genocide- The deliberate and systematic destruction of an ethnic, racial, religious, or national group. Recent and historical examples of genocides include Wounded Knee, the Rwandan genocide and the Holocaust.

globalization- In its literal sense is the process of globalizing, transformation of some things or phenomena into global ones. It can be described as a process by which the people of the world are unified into a single society and function together. This process is a combination of economic, technological, sociocultural and political forces.

Globalization is very often used to refer to economic globalization, that is integration of national economies into the international economy through trade, foreign direct investment, capital flows, migration, and the spread of technology.

life expectancy - The average length of survival for a human population. In the U.S. the overall average life expectancy for men and women of all races is 77.8 years. In the

U.S. the average length of survival differs depending on where you live, the color of your skin, and your class. For example, African Americans still expect to live 6-10 fewer years than Whites. health disparity (-ies) - Differences in health status between different groups such as racial, ethnic, and socioeconomic groups. health equity - The absence of preventable and unfair differences in the determinants and manifestations of good health and longevity between the most vulnerable groups and groups that are well off. health inequity - Preventable gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups that are the result of systematic and unjust

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot distribution of social, economic, and environmental conditions needed for health. Health inequities are also considered to be health disparities, with the difference being that differences in health status are the result of social injustice shaped by societal, economic and political factors not innate biological differences between groups. incidence- The number of new cases of a disease over a specified period of time.

industrialized nation (-s) Refers to developed countries where the majority of the economies are made up of service industries such as insurance, entertainment and intellectual services such as research and education. These countries also have a high incomes, or money coming in. immigrant- A person who migrates to another country, usually for permanent residence.

infant mortality rate (IMR)- The number of newborns dying under a year of age divided by the number of live births during the year. The infant mortality rate is also called the infant death rate. In Boston, the IMR for Black babies is three times higher compared to

White babies.

institutional racism Differential access to the goods, services, and opportunities of society by race

.

Manifests itself both in material conditions and in access to power. With regard to material conditions, examples include differential access to quality education, sound housing, gainful employment, appropriate medical facilities, and a clean environment. With regard to access to power, examples include differential access to information (including one’s own history), resources (including wealth and organizational infrastructure), and voice (including voting rights, representation in government, and control of the media).

internalized racism Defined as acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth. It is characterized by their not believing in others who look like them, and not believing in themselves.

Latino health paradox- The health advantage that newly arriving Latino immigrants have compared to the U.S. population. It is know as a paradox because newly arriving

Latino immigrants who often have less education, lower income and less access to health care systems than individuals born in the United States, have better health on average than the average American.

life course approach – Approach that looks at how chronological age, common life transitions, and social change shape people’s lives from birth to death and impact their health. It is used to explain variations in disease incidence , and lifestyle risks to developing chronic diseases cannot be attributable solely to either early life or adult experiences but instead operate cumulatively throughout life. living standard (AKA standard of living)- Refers to the quality and quantity of goods and services available to people, and the way these goods and services are distributed

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot within a population. It is generally measured by standards such as access and quality of health care, educational standards and social rights, among others. migration- The process of going from one country, region, or place to another.

mixed income community- Housing developments (achieved through a variety of policies and practices) that contain units that are affordable to households with different income levels, whether the households earn an above-moderate income, a moderate income (80 to 120 percent of the area median income (AMI)), a low income (50 to 80 percent of the AMI), or in some cases, a very low income (below 50 percent of the AMI).

morbidity- Living but permanently sick from a disease that you have. mortality- Deaths from a disease or injury. For example, in the U.S. Blacks face higher rates of illness and mortality than Whites.

outsourcing - To obtain goods or services from an outside source, for example: U.S. companies who outsource from China. pension Money paid under given conditions to a person following retirement or to surviving dependents.

people of color- A term used to refer to nonwhite people, used instead of the term

"minority," which implies inferiority and disenfranchisement. The term emphasizes common experiences of racial discrimination or racism.

personally mediated racism – Also known as interpersonal racism. Defined as prejudice and discrimination, where prejudice means differential assumptions about the abilities, motives, and intentions of others according to their race, and discrimination means differential actions toward others according to their race. This is what most people think of when they hear the word “racism.” Personally mediated racism can be intentional as well as unintentional, and it includes acts of commission as well as acts of omission. It manifests as lack of respect (poor or no service, failure to communicate options), suspicion (shopkeepers’ vigilance; everyday avoidance, including street crossing, purse clutching, and standing when there are empty seats on public transportation), devaluation (surprise at competence, stifling of aspirations), scapegoating and dehumanization (police brutality, sterilization abuse, hate crimes). policy A plan of action adopted by an individual or social group that can either be voluntary or mandatory. poverty tax- According to a Brookings Institution study, not only do poor neighborhoods have fewer parks, fewer supermarkets, worse schools, more environmental hazards, higher crime and neglected public spaces, residents pay more for the exact same consumer products than those in higher income neighborhoods– more for auto loans, furniture, appliances, bank fees, and even groceries. And homeowners get less return

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot on their property investments. The “tax,” adding up to hundreds, even thousands of dollars, further impoverishes those who are already poor. predisposition- Susceptibility to a particular condition due to a person’s genes.

Symptoms may or may not be present, depending on the environmental factors.

prenatal care- Describes the health and supportive services provided to a woman during her pregnancy. Prenatal care generally consists of an ordered series of visits to health professionals, with the visits occurring monthly early in the pregnancy and weekly during the last month of pregnancy.

pre-term birth- Most pregnancies last around 40 weeks. Babies born between 37 and

42 completed weeks of pregnancy are called full term. Babies born before 37 completed weeks of pregnancy are called premature or pre-term. Pre-term or premature birth is a serious health problem. Premature babies are at increased risk for newborn health complications, as well as lasting disabilities, such as mental retardation, cerebral palsy, lung and gastrointestinal problems, vision and hearing loss, and even death. Many premature babies require care in a neonatal intensive care unit (NICU), which has specialized medical staff and equipment that can deal with the multiple problems faced by premature infants.

prevalence- Number of disease cases overall both new and existing. psychiatric disorders or mental illness are terms used to refer to a psychological or physiological pattern that occurs in an individual and is usually associated with distress or disability that is not expected as part of normal development or culture.

public health - The combination of science, practical skills, and values directed to the maintenance and improvement of the health of all people. It is a set of efforts organized by society to protect, promote, and restore the people's health through collective and social action. race A social construct that artificially divides people into distinct groups based on characteristics such as physical appearance (particularly skin color), ancestral heritage, cultural affiliation, cultural history and the social, economic, and political needs of a society at a given period in time. Race is not a biological phenomena that reflects innate differences.

racism- The systemic institutionalization of race-based prejudice, privilege and power that manifests in discrimination and oppression of racial minorities in a society, described by Dr. Camara Jones as having three levels: internalized, personally mediated and institutional. rate - In statistics, the number of new cases, or people getting sick, over a specific period of time, usually in comparison with another period of time of with another population during the same period.

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot resilience- The ability to recover quickly from illness, change, or misfortune; an ability to recover from or adjust easily to misfortune or change. risk factor- A characteristic, condition or behavior, such as high blood pressure or smoking, that increases the possibility of disease or injury. root cause- the principle, underlying, and/or original source or cause of something. self-sufficiency- Refers to the state of not requiring any outside aid or support for survival. The term is also applied to limited forms of self-sufficiency, for example growing one's own food or becoming economically independent of state subsidies or (in the case of larger political entities) foreign aid.

social conditions- The state of society as it exists or in flux. Usually refers to society as a whole in a specified geographical or political region and can also be applicable also to restricted strata of a society, i.e. poor, middle class, rich. socio-economic status (SES) A term that describes the position of an individual group in a population or society, reflecting the overall hierarchy. The most frequently used indicators of SES are income, education and occupational categories. social determinant (-s of health) Life and health enhancing resources, such as food supply, housing, economic and social relationships, transportation, education and health care, whose distribution across populations effectively determines length and quality of life. Also can be understood as the social conditions in which people live and work. social exclusion relates to the alienation or disenfranchisement of certain people within a society. It is often connected to a person's social class, educational status and living standards and how these might affect their access to various opportunities. It also applies to some degree to people with a disability, to minority men and women of all races, and to the elderly. Anyone who deviates in any perceived way from the norm of a population can become subject to coarse or subtle forms of social exclusion. social justice- Refers to the concept of a society in which justice is achieved in every aspect of society, rather than solely the administration of law. It can also refer to the distribution of opportunity within a society. Philosophically there is no universal agreement as to what social justice is or looks like in a given society, given the plurality of perspectives of what it means.

social inclusion A strategy to change the circumstances and habits that lead to (or have led to) social exclusion. See social exclusion.

stress- The rate of wear and tear in the body. A physical condition, usually affecting behavior, the result of excessive environmental or psychological pressures.

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Unnatural Causes Companion Guide – DRAFT 4 BPS Pilot stressor (multiple negative)- An event or context that elevates adrenaline and triggers the stress response because it throws the body out of balance and forces it to respond; for example:

* environmental stressors (elevated sound levels, over-

illumination, overcrowding)

* daily stress events (e.g. traffic, lost keys)

* life changes (e.g. divorce, bereavement)

* Workplace stressors (e.g. role strain, lack of control)

A stressor can also be an event that provokes stress.

tuberculosis (TB)- An infectious disease caused by the bacterium Mycobacterium tuberculosis that is transmitted through inhalation and is characterized by cough, fever, shortness of breath, weight loss, and the appearance of inflammatory substances and tubercles in the lungs. Tuberculosis is highly contagious and can spread to other parts of the body, especially in people with weakened immune systems.

Type II diabetes (also known as Diabetes mellitus type 2)- A metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency and hyperglycemia. It is often managed by engaging in exercise and modifying one's diet way of life- A course of group or individual conduct which may be guided or directed by one’s religious or spiritual beliefs, culture or social class among other things.

wealth - Abundance of items of economic value, encompasses money, real estate and personal property. Also measured as what you owe minus what you own. wealth-health gradient - Connection between one’s wealth and one’s health where for each step of the wealth ladder one finds a corresponding step to health. Those at the top have the best health and those at the bottom have the poorest health.

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!

Unnatural Causes Youth Companion Guide Collaborators

Guide Developers

Tara Agrawal,Policy Analyst, Office of Health Equity, Boston Public Health Commission, www.bphc.org

/disparities

Earlene Avalon, Health Engagement Coordinator, Health Careers Academy

Elizabeth A. Buckley, Senior, Boston Public Schools Office of High School Support

Marco Cenafils, Boston Area Health Education Center (BAHEC), Boston Public Health

Commission, www.bphc.org

James Hills, Special Assistant to Mayor Thomas M. Menino, City of Boston

Peter Holtgrave, Director, Boston Area Health Education Center (BAHEC), Boston

Public Health Commission, www.bphc.org

Meleni Mhlaba, Public Health Educator, Adolescent Wellness Program, Boston Public

Health Commission.

Bernadette Moitt, Boston Public Health Commission, www.bphc.org

Latoya Tiffany-Robinson, STAND Coordinator, Bunker Hill Community College

Pat Toney, Program Development Specialist, Roxbury Multi-Service Center

Katherine Rushfirth, Project Manager, Center for Community Health

Education, Research and Service (CCHERS) General contact: 617-373-4591 info@cchers.org

Guide Reviewers

Courtney Boen, Policy Analyst, REACH US Center of Excellence in the Elimination of

Disparities, Boston Public Health Commission. www.bphc.org

Meghan Patterson, Director, Office of Health Equity, Center for Health Equity and Social

Justice, Boston Public Health Commission. www.bphc.org.disparities

Mark Pedulla, Manager of Organizing and Policy Initiatives, Hyde Square Task Force. www.hydesquare.org

Jeremy Phillips, Principal, Jeremy Phillips Consulting.

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104

Unnatural Causes-Teachers Guide

UNNATURAL CAUSES: Is

Inequality Making Us Sick?

A YOUTH COMPANION GUIDE

Unnatural Causes: Is Inequality Making Us Sick?

Session 1: Introduction to Health, the Social Determinants of Health,

Health Disparities and Health Equity

SESSION 2: RACISM AND HEALTH

.

Session 3: Episode One: In Sickness and In Wealth (56 mins.)

C. Why So Stressed? (25-35 mins.)

Session 4- Episode Two: When the Bough Breaks (29 mins.)

III. Key Session Vocabulary

VII. Suggested Activities

.

Session 5: Episode 3-Becoming American (29 mins.)

Session 6: Episode Four- Bad Sugar (29 mins.)

Discussion Questions

Session 7: Episode Five- Place Matters (28 mins.)

Session 8: Episode Six-Collateral Damage (29 mins.)

Session 9: Episode Seven-Not Just A Paycheck (30 mins.)

APPENDICES

Appendix A: Suggestions and Resources for English Language

Learners (ELL)

Appendix B: Icebreakers/Energizers of Any Sessions

Appendix C: Activity Ideas for Any Session

Appendix D: Episode Viewing Sheets

Appendix E: Culminating Experience Project Suggestions

Appendix F: Additional Resources From the California Newsreel

Appendix F: Federal, State and Local Health Agencies

Appendix G: Glossary of Terms

Is a market model in which the trade of goods and services between or within countries flows unhindered by government-imposed restrictions, which may increase costs to goods and services, producers, businesses, and customers.

Unnatural Causes Youth Companion Guide Collaborators

Related documents

Products

Support

Unnatural Causes-Teachers Guide

UNNATURAL CAUSES: Is

Inequality Making Us Sick?

A YOUTH COMPANION GUIDE

Unnatural Causes: Is Inequality Making Us Sick?

Session 1: Introduction to Health, the Social Determinants of Health,

Health Disparities and Health Equity

SESSION 2: RACISM AND HEALTH

.

Session 3: Episode One: In Sickness and In Wealth (56 mins.)

C. Why So Stressed? (25-35 mins.)

Session 4- Episode Two: When the Bough Breaks (29 mins.)

III. Key Session Vocabulary

VII. Suggested Activities

.

Session 5: Episode 3-Becoming American (29 mins.)

Session 6: Episode Four- Bad Sugar (29 mins.)

Discussion Questions

Session 7: Episode Five- Place Matters (28 mins.)

Session 8: Episode Six-Collateral Damage (29 mins.)

Session 9: Episode Seven-Not Just A Paycheck (30 mins.)

APPENDICES

Appendix A: Suggestions and Resources for English Language

Learners (ELL)

Appendix B: Icebreakers/Energizers of Any Sessions

Appendix C: Activity Ideas for Any Session

Appendix D: Episode Viewing Sheets

Appendix E: Culminating Experience Project Suggestions

Appendix F: Additional Resources From the California Newsreel

Appendix F: Federal, State and Local Health Agencies

Appendix G: Glossary of Terms

Is a market model in which the trade of goods and services between or within countries flows unhindered by government-imposed restrictions, which may increase costs to goods and services, producers, businesses, and customers.

Unnatural Causes Youth Companion Guide Collaborators

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